Note: Some citations in the text of this section are followed by a level of evidence. The PDQ editorial boards use a formal ranking system to help the reader judge the strength of evidence linked to the reported results of a therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more information.)
Craniopharyngiomas are histologically benign and do not metastasize to remote brain locations or to areas outside the sellar region except by direct extension. They may be invasive, however, and may recur locally. They may be classified as adamantinomatous or squamous papillary, with the former being the predominant form in children. They are typically composed of both a solid portion with an abundance of calcification, and a cystic component which is filled with a dark, oily fluid. Recent evidence...
About 10% to 20% of patients with cancer will have a single brain metastasis. The extent of extracranial disease can influence subsequent treatment of the brain lesions. In the presence of extensive systemic disease, surgery provides little benefit for overall survival (OS). In patients with minimal extracranial disease, combined modality treatment should be used. Treatment is usually surgical resection followed by radiation therapy. In a randomized trial, this approach showed that patients who received whole-brain radiation therapy (WBRT) after resection were much less likely to fail in the brain and were significantly less likely to die of neurological causes, but OS was the same.
A Radiation Therapy Oncology Group (RTOG) study (RTOG-9508) randomized patients with one to three metastases with a maximum diameter of 4 cm to WBRT with or without a stereotactic boost. The combined-treatment group had a survival advantage of 2½ months in patients with a single metastasis but not in patients with multiple lesions. Local control was significantly better in all groups with combined therapy.[Level of evidence: 1iiDii]
Treatment for patients with multiple metastases:
Patients with multiple brain metastases are treated with WBRT. Surgery is reserved only for large symptomatic lesions or for obtaining tissue with an unknown primary. Stereotactic radiation surgery in combination with WBRT has been assessed and has been shown to give good local control, but median survival was not affected. Survival was determined by the extent of extracranial disease. Stereotactic radiosurgery as a sole modality has been used; however, no randomized studies comparing that modality with a combined modality treatment have been done to evaluate the effect on survival. An RTOG study randomized patients with one to three metastases with a maximum diameter of 4 cm to WBRT with or without a stereotactic boost. The combined-treatment group had a survival advantage of 2 1/2 months in patients with a single metastasis but not in patients with multiple lesions. Local control was significantly better in all groups with combined therapy.[Level of evidence: 1iiDii]
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with adult brain tumor. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.