Outcomes of Pediatric Craniopharyngioma Treated with Proton Radiation Therapy

Results: Eighty-three patients met the inclusion criteria. The mean pre-RT Hb value was 11.0 g/dL (SD = 2.1 g/dL), the mean Hb nadir during RT was 9.9 g/dL (SD = 1.9 g/dL), and the mean average weekly Hb nadir was 10.9 g/dL (SD = 1.4 g/dL). Forty-one patients met the criteria for anemia at some point during RT. The median RT dose was 50.4 Gy (range, 20–70 Gy), with a median follow-up of 31 months (range, 5–106 months). Anemic patients with an average weekly Hb nadir \ 10 g/dL had worse 5 year outcomes than those $ 10 g/dL: LC (31.2% vs. 79.0%, p = 0.03), DMFS (42.9% vs. 71.3%, p = 0.004), DFS (18.9% vs. 57.9%, p = 0.008), and OS (83.9% vs. 94.1%, p = 0.004). During treatment, 43% of the patients received PRBCs, with a median of 9 days from the start of RT to the first transfusion. Those receiving transfusions had worse 5 year LC rates, 82.3% vs. 56.2% (p = 0.03), and 5 year DFS rates, 63.4% vs. 28.5% (p = 0.009), than those not requiring a transfusion, respectively. Results of Cox multivariate analysis showed that LC was influenced by pre-treatment Hb (RR = 0.49 p \ 0.001), Hb nadir (RR = 0.77 p=0.05), number of transfusions (RR = 0.77 p = 0.05), and days to first transfusion (RR = 0.77 p = 0.05).