Stereotactic Radiation as Salvage Therapy for Recurrent Rathke Cleft Cysts.
BACKGROUND
Rathke cleft cysts (RCCs) are sellar-based cystic lesions that are often found incidentally but occasionally become symptomatic with significant visual and/or endocrine deficits. The standard of treatment is surgery, but rare cases of multiply recurrent RCCs can be refractory to surgical drainage, leading to significant morbidity.


OBJECTIVE
To demonstrate the safety and feasibility of fractionated stereotactic radiotherapy (SRT) as salvage therapy in multiply recurrent RCCs refractory to surgical drainage.


METHODS
An IRB-approved retrospective review at a single institution was conducted to identify and describe patients with multiply recurrent RCCs refractory to surgical drainage who underwent SRT.


RESULTS
From 1994 to 2015, 6 patients (5 female) who underwent SRT for recurrent RCCs were identified. A total of 4 presented with visual deficits, and 2 presented with endocrine dysfunction and severe headaches prior to their initial drainage. All patients had initial postoperative improvement but then developed multiple, symptomatic recurrences. Median number of surgical drainage procedures prior to radiotherapy was 3. A total of 3 patients underwent LINAC-based SRT, and 3 had proton-based SRT. Treatment doses were 45 Gy over 25 fractions (n = 5) and 50.4 Gy over 28 fractions (n = 1). Median follow-up after radiation therapy was 69 mo (range 24-154 mo). In the follow-up period, stabilization of the RCC was achieved, although 2 patients required additional drainage procedures. Only 1 patient developed new hypothyroidism and hypoadrenalism after SRT.


CONCLUSION
In rare cases of multiply recurrent RCCs refractory to repeat surgical drainage, stereotactic fractionated radiation therapy is a safe and effective salvage therapy.
['Agarwalla|Pankaj K|PK|', 'Koch|Matthew J|MJ|', 'Royce|Trevor J|TJ|', 'Redjal|Navid|N|', 'Bussière|Marc R|MR|', 'Loeffler|Jay S|JS|', 'Swearingen|Brooke|B|']
D000368:Aged D001932:Brain Neoplasms D020863:Central Nervous System Cysts D004322:Drainage D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D009364:Neoplasm Recurrence, Local D016634:Radiosurgery D012189:Retrospective Studies D016879:Salvage Therapy
Rathke cleft cyst Stereotactic radiotherapy LINAC Proton