The interdisciplinary management of craniopharyngioma - practice patterns, outcomes, and insights.
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BACKGROUND: Craniopharyngiomas are rare, mostly benign brain tumors, and their management remains challenging due to the limited data from large cohorts. This study evaluates the practice patterns and outcomes for craniopharyngioma patients managed at a tertiary care center. METHODS: This retrospective cohort study included patients with histologically confirmed craniopharyngioma treated between 1996 and 2022. Patient, tumor, and treatment variables were analyzed for their association with local control (LC), progression-free survival (PFS), and overall survival (OS) using multivariable Cox regression models. RESULTS: A total of 88 patients were analyzed. The median clinical and radiographic follow-up periods were 62.0 and 42.5 months, respectively. Fifty-three recurrences and twelve deaths were observed. After primary treatment, the 2-, 4, and 6-year LC and PFS rates were 69.1, 50.7, 37.7% and 71.5, 55.4, and 47.3%, respectively. For patients undergoing primary treatment, multivariable Cox regression showed an association between the extent of resection, i.e., gross total resection (GTR), and PFS (hazard ratio (HR): 0.36, p = 0.01) with weaker evidence for LC (HR: 0.40, p = 0.053). Age was the only variable associated with OS (HR: 1.05, p = 0.01). Seventeen patients received radiotherapy, which was not formally associated with LC, PFS, and OS. The majority of patients required hormone replacement therapy after treatment. CONCLUSIONS: This study underlines the role of GTR in delaying disease progression and the need for hormone replacement after treatment. While radiotherapy was not formally associated with any benefit in this series, its use might be helpful in candidates after subtotal resection and for treating recurrences. Further prospective research is needed to refine treatment algorithms, improve long-term outcomes, and optimize the quality of life of affected patients.