适形放疗
调强放疗 (intensity-modulated radiotherapy, IMRT) 通过调整放射治疗的线束,使得外照射分割放疗更为精准,对正常脑组织暴露剂量更少,而肿瘤部位的剂量更高。然而,较传统的放疗,费用更加昂贵,且相关临床研究较少。[37]Minniti G, Saran F, Traish D, et al. Fractionated stereotactic conformal radiotherapy following conservative surgery in the control of craniopharyngiomas. Radiother Oncol. 2007;82:90-95.http://www.ncbi.nlm.nih.gov/pubmed/17161483?tool=bestpractice.com[53]Merchant TE, Kiehna EN, Kun LE, et al. Phase II trial of conformal radiation therapy for pediatric patients with craniopharyngioma and correlation of surgical factors and radiation dosimetry with change in cognitive function. J Neurosurg. 2006;104(suppl 2):94-102.http://www.ncbi.nlm.nih.gov/pubmed/16506496?tool=bestpractice.com
光子放疗
质子(或其他重粒子)放疗能够准确照射肿瘤靶区,对周围正常脑组织损伤很小。与立体定向放疗相似,这些肿瘤靶向治疗可能增加放射剂量。然而,仅有少数中心能够开展质子放疗。因此,尽管这种方法较为合理,研究较少是其局限性。[54]Fitzek MM, Linggood RM, Adams J, et al. Combined proton and photon irradiation for craniopharyngioma: long-term results of the early cohort of patients treated at Harvard Cyclotron Laboratory and Massachusetts General Hospital. Int J Radiat Oncol Biol Phys. 2006;64:1348-1354.http://www.ncbi.nlm.nih.gov/pubmed/16580494?tool=bestpractice.com
化疗/生物治疗/靶向治疗
很少有研究报道关于化疗在颅咽管瘤治疗中的作用。一项小型临床试验显示,对于难治性颅咽管瘤患者,皮下注射干扰素-α 可起到姑息性的获益效果,[55]Jakacki RI, Cohen BH, Jamison C, et al. Phase II evaluation of interferon alpha-2a for progressive or recurrent craniopharyngiomas. J Neurosurg. 2000;92:255-260.http://www.ncbi.nlm.nih.gov/pubmed/10659012?tool=bestpractice.com 并且有进一步的研究报道,使用干扰素-α 的肿瘤内化疗能有效控制囊性颅咽管瘤,[56]Cavalheiro S, Di Rocco C, Valenzuela S, et al. Craniopharyngiomas: intratumoral chemotherapy with interferon-alpha: a multicenter preliminary study with 60 cases. Neurosurg Focus. 2010;28:E12.http://www.ncbi.nlm.nih.gov/pubmed/20367356?tool=bestpractice.com 但此疗法仍处于研究阶段。然而,随着该疾病分子肿瘤学的发展,靶向于特定基因或特定基因产物通路的治疗已成为可能(例如上调 β-连环蛋白)。[16]Hofmann B, Kreutzer J, Saeger W, et al. Nuclear beta-catenin accumulation as reliable marker for the differentiation between cystic craniopharyngiomas and rathke cleft cysts: a clinico-pathologic approach. Am J Surg Path. 2006;30:1595-1603.http://www.ncbi.nlm.nih.gov/pubmed/17122517?tool=bestpractice.com