Clinical Trial Finder

Inclusion Criteria:

• - Craniopharyngioma diagnosed by histology, cytology or neuroimaging or intra-operative assessment.

• - Patients ages 0-21 years at the time of diagnosis.

Exclusion Criteria:

• - Prior history of fractionated radiation therapy.

• - Prior treatment with intracystic P-32 or intracystic bleomycin.

• - Pregnant females are excluded.

Radiation has teratogenic or abortifacient effects

This study will include participants who are diagnosed or presumed to have craniopharyngioma based on neuroimaging, intra-operative assessment, or the evaluation of cyst fluid or tissue after limited or radical surgery. When possible, participants will be enrolled on protocol prior to surgery. PRIMARY OBJECTIVE:

• - To estimate the distributions of progression-free and overall survival for children and young adults with craniopharyngioma treated with intensity-modulated proton therapy while monitoring for excessive central nervous system necrosis, clinically significant vasculopathy, and permanent neurological conditions or deficits.

SECONDARY OBJECTIVES:

• - To estimate the cumulative incidence of cystic intervention and the event-free survival distribution for children and young adults with craniopharyngioma treated with intensity-modulated proton therapy; and to compare the distributions of progression-free, event-free and overall survival with the distributions for the St. Jude Children's Research Hospital (SJCRH) cohort of patients treated with photon therapy on which the design of this trial is based.

• - To estimate the cumulative incidence of cystic intervention and the distributions of progression-free survival, overall survival and the event-free survival for children and young adults with craniopharyngioma treated only with primary surgical resection and to compare these distributions with the distributions observed for patients treated with proton therapy.

OTHER PRE-SPECIFIED OBJECTIVES:

• - To explore potential associations of clinical and treatment factors with the incidence and severity of neurological, endocrine and cognitive deficits in children and young adults with craniopharyngioma treated with radical surgery or proton therapy.

Descriptively compare findings for patients treated with proton therapy with the reported findings for the updated SJCRH cohort treated with photon therapy.

• - Using specific measures of sleep quality, excessive daytime sleepiness, daytime activity, circadian rhythm, fatigue, symptom distresses, and quality of life, explore associations of sleep, fatigue and quality of life with other measures of central nervous system (CNS) effects, clinical and treatment factors in children and young adults with craniopharyngioma treated with radical surgery or proton therapy.

• - To evaluate and explore differences in physical performance and movement in children and young adults with craniopharyngioma treated with radical surgery or proton therapy, using specific measures of overall physical performance, flexibility, balance, coordination, muscle strength and power, and cardiopulmonary fitness.

• - Estimate and compare the response of residual tumor and the incidence and severity of structural, functional and vascular effects of normal brain in children and young adults with craniopharyngioma after treatment with radical surgery or proton therapy using specific methods of diffusion, contrast-enhancement, vascular and functional neuroimaging, and explore the association between these and other measures of CNS effects and clinical and treatment factors.

• - Investigate the feasibility of using positron emission tomography (PET) as an in vivo dose and distal edge verification system for craniopharyngioma patients treated with proton therapy.

• - Measure growth factor and cytokine responses in children and young adults with craniopharyngioma after treatment with radical surgery or proton therapy, and explore associations between these and other measures of CNS effects and clinical and treatment factors.

Descriptively compare findings for patients treated with proton therapy with the reported findings for the updated SJCRH cohort treated with photon therapy.

Arms

Active Comparator: Tumor-Surgery

Participants who are eligible to undergo surgery to remove the tumor will proceed to surgery. If all tumor is removed, they will be followed over 5 years for outcome comparison to the other participant groups. If the entire tumor is not removed by surgery, participants will receive 6 weeks of proton therapy. They will then be followed for 5 years to collect outcome data for comparison to the other participant groups.

Active Comparator: Tumor-No Surgery

Participants whose tumor cannot be resected through surgery will receive 6 weeks of proton therapy. They will then be followed over 5 years for outcome comparison to the other participant groups.

Interventions

Radiation: - Proton Therapy

The protocol-specific radiation dose will be prescribed to a target defined by the use of computerized tomography (CT) and magnetic resonance imaging (MRI). The target will encompass the residual tumor and/or tumor bed and will include a margin mean to treat subclinical microscopic disease. There is no time limit for the interval from surgery or study enrollment to when proton therapy commences. The time course of administration of proton therapy will be 1 treatment/day, 5 days/week, for a period 6 weeks.

Procedure: - Surgery

When possible, tumors will be removed surgically prior to proton therapy. If no tumor remains following surgery, no proton therapy will be given, and participants will be followed for 5 years to collect outcome data for comparison between groups.