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Fractionated stereotactic radiotherapy in craniopharyngiomas: A systematic review and single arm meta-analysis

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Abstract

Introduction

Numerous studies have demonstrated Fractionated Stereotactic Radiotherapy's (FSRT) effectiveness in tumor control post-resection for craniopharyngiomas. Nevertheless, past literature has presented conflicting findings particularly regarding endocrine and visual function outcomes. This study aims to elucidate FSRT's efficacy and safety for this population.

Methods

Adhering to PRISMA, a systematic review and meta-analyses was conducted. Included studies had to report the effects of FSRT for treating craniopharyngiomas in a sample greater than four patients, addressing at least one of the outcomes of interest: improvement in visual acuity or field, new-onset hypopituitarism, effectiveness, and tumor progression. Relative risk with 95% confidence intervals were used to assess the outcomes.

Results

After retrieving a total of 1292 studies, 10 articles met the predefined criteria and thus were finally selected, amounting to a total of 256 patients. The improvement in visual acuity was estimated at 45% (95% CI: 6–83%), while the improvement in the visual field was 22% (95% CI: 0–51%). Regarding endocrine function, the new-onset hypopituitarism rate was found to be 5% (95% CI: 0–11%). Relative to FSRT effectiveness, the pooled estimate of the complete tumor response rate was 17% (95% CI: 4–30%), and the tumor progression rate was 7% (95% CI: 1–13%). Also, a 3-year progression-free survival rate of 98% (95% CI: 95–100%) was obtained.

Conclusion

Despite limitations and risks, FSRT shows promise as a viable therapeutic option for craniopharyngiomas, offering notable benefits for visual functions and tumor control. Further research is required to better understand the associated risks, benefits, and clinical utility.

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Data availability

No datasets were generated or analysed during the current study.

Abbreviations

FSRT:

Fractionated Stereotactic Radiotherapy

GTR:

Gross total resection

NA:

Not Available

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analysis

PFS:

Progression-Free Survival

QOL:

Quality of life

RT:

Radiation therapy

ROBINS-I:

Risk Of Bias In Non-randomized Studies

RR:

Relative Risk

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Funding

This research received no specific grant from public, commercial, or not-for-profit funding agencies.

Author information

Authors and Affiliations

  1. Max Planck University Center, Indaiatuba, SP, Brazil

    Lucca B. Palavani

  2. Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil

    Guilherme Melo Silva, Marcelo Porto Sousa & Sávio Batista

  3. Technical-Educational Foundation Souza Marques, Rio de Janeiro, RJ, Brazil

    Pedro G. L. B. Borges

  4. Postgraduate Program in Translational Surgery of Federal University of São Paulo, São Paulo, SP, Brazil

    Márcio Yuri Ferreira

  5. Faculty of Medicine Santa Marcelina, São Paulo, SP, Brazil

    Marianna G. H. S. J. Leite

  6. Department of Neurosurgery, State University of Ponta Grossa, Ponta Grossa, PR, Brazil

    Leonardo de Barros Oliveira

  7. Department of Neurosurgery, University of São Paulo, São Paulo, SP, Brazil

    Raphael Bertani & Wellingson Paiva

  8. Neurosurgical Oncology Division, Barretos Cancer Hospital, Barretos, SP, Brazil

    Allan Dias Polverini

  9. Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA

    André Beer-Furlan

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  1. Lucca B. Palavani
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Contributions

The project credits are as follows: Lucca B Palavani contributed to conceptualization, methodology, software development, original draft writing, investigation, and data curation. Guilherme Melo Silva was involved in original draft writing, formal analysis, investigation, data curation, and methodology. Pedro Borges contributed to data curation, investigation, original draft writing, and formal analysis. Márcio Yuri Ferreira participated in original draft writing, data curation, and investigation. Marcelo Porto Sousa contributed to original draft writing, data curation, and software development. Marianna G. H. S. J. Leite was involved in original draft writing, data curation, software development, and methodology. Leonardo de Barros Oliveira contributed to writing review and editing, as well as methodology. Sávio Batista was involved in writing review and editing, software development, and formal analysis. Raphael Bertani supervised the project, handled project administration, and participated in writing review and editing. Allan Dias Polverini also supervised the project, handled project administration, and contributed to writing review and editing, as well as visualization. André Beer-Furlan supervised the project and participated in project administration and writing review and editing. Wellingson Paiva contributed to conceptualization, supervision, project administration, writing review and editing, and visualization.

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Correspondence to Leonardo de Barros Oliveira.

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Palavani, L.B., Silva, G.M., Borges, P.G.L.B. et al. Fractionated stereotactic radiotherapy in craniopharyngiomas: A systematic review and single arm meta-analysis. J Neurooncol (2024). https://doi.org/10.1007/s11060-024-04621-6

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