Reirradiation for Recurrent Craniopharyngioma—Long-Term Follow-up

Purpose To report long-term tumor control, toxicity, and functional outcomes after a second course of fractionated radiation therapy for recurrent craniopharyngioma previously treated with radiation therapy. Methods and Materials We identified all patients with craniopharyngioma with recurrent or progressive disease, unsuitable for further medical management or re-resection, who underwent 2 courses of fractionated photon radiation therapy at a single institution between 1998 and 2024. Reirradiation was delivered to 54 Gy in 30 fractions with full overlap of the initial target; dose constraints to optic nerves, chiasm, and brainstem were Dmax/D0.03cc (Maximum Dose or Dose to 0.03 cubic centimetres) ≤54 Gy. Outcomes were summarized descriptively. Results Six patients received reirradiation a mean of 9.8 years (range, 5.6-20.5) after initial radiation therapy (50-54 Gy in 25-30 fractions). Median follow-up after reirradiation was 4.1 years (range, 0.4-8.8). At the last follow-up, 4 patients were alive, all with local disease control (2 with radiological regression, 2 with stable disease). Two deaths occurred (1 due to progressive disease and 1 due to functional decline with stable imaging). Visual outcomes were heterogeneous: 1 patient maintained intact vision; others had intermittent diplopia, bitemporal hemianopsia, or unilateral blindness with contralateral impairment. Endocrinopathy was frequent: 3 of 4 survivors had pan-hypopituitarism; 1 had partial deficits (hypothyroidism/amenorrhea). Functional status was impaired in survivors, with the inability to work or study due to fatigue, visual loss, or cognitive issues. Additional toxicities included posttreatment seizures requiring hospitalization (n = 1) and transient dexamethasone for headache (n = 1). Conclusions In carefully selected patients lacking other curative options, modern highly conformal reirradiation can achieve meaningful local control after prior high-dose radiation therapy, but carries an additive risk of visual, endocrine, and functional morbidity. Decisions should be individualized within a multidisciplinary team to identify appropriate cases for reirradiation and to ensure thorough long-term follow-up to manage delayed toxicity.