CRAN-30. HIGH PRECISION STEREOTACTIC CONFORMAL RADIOTHERAPY (SCRT) IMPROVES THE LONG TERM FUNCTIONAL OUTCOME IN CHILDREN AND ADOLESCENT PATIENTS OF CRANIOPHARYNGIOMA: DATA FROM A PROSPECTIVE RANDOMIZED TRIAL

Abstract

BACKGROUND: To compare the clinical and functional outcome in young patients with craniopharyngioma treated with Stereotactic Conformal focal radiotherapy (SCRT) and conventional RT(ConvRT). METHODS: Patients were assigned to either SCRT or ConvRT to a dose of 54 Gy in 30 fractions over 6 weeks. 82 patients (SCRT:39 & ConvRT 43; median age-11years [IQR: 8-17]) diagnosed with craniopharyngioma underwent serial longitudinal neurocognitive domains which included Full Scale Intelligence Quotient(FSIQ), Performance Quotient(PQ), Verbal Quotient(VQ), Memory Quotient(MQ) and neuroendocrine evaluation at baseline and follow-up after RT. RESULTS: Mild hydrocephalus was observed in 80% patients. NPS (0-1) was seen in 64% patients. Vision was impaired in 7%. Pre-RT mean VQ/MQ, PQ and FSIQ were 85.15, 83.90 and 79.38 and improved to 96.73(p=0.07), 101.79(0.002) and 87.71(p=0.06) respectively at 5 years post RT. Improvement in all the neurocognitive domains were better with SCRT technique as opposed to ConvRT technique over a period of 5 years [FSIQ(difference in slopes:-0.67), PQ(difference of slope:-1.22), VQ/MQ(difference of slope:0.57)]. At a median follow-up of 5.4 years (IQR 3.8-7.2),80(97.5%)patients were locally controlled. 10-year overall survival and local control with SCRT was 74.1% & 97% compared to 80.6% & 95.2% with ConvRT. Cumulative incidence of developing any neuroendocrine dysfunction was lower in SCRT arm (12/39 patients, 30.7%) compared to ConvRT arm (20/43 patients, 45.6%). CONCLUSION: In young patients of craniopharyngioma requiring radiotherapy for long-term tumour control, SCRT as compared to ConvRT achieves superior neurocognitive and neuroendocrine functional outcomes over 5 years without compromising local control or survival.