Would you offer adjuvant radiation therapy in a young adult with NF1 who has a craniopharyngioma s/p STR?

In NF1 patients, radiation therapy for craniopharyngioma has been associated with vascular damage and Moya Moya syndrome. On the other hand, subtotally resected craniopharyngiomas have a high chance of recurrence. It has been shown that, dosimetrically, intensity-modulated proton therapy (IMPT) could deliver less radiation dose to the arteries than intensity-modulated X/ray therapy (IMRT). Thus, IMPT could produce less risk of vascular damage than IMRT. I would suggest referring the patient to a...

In treating a young adult with NF1 and residual craniopharyngioma following a subtotal resection (STR), my approach would be the same, regardless of the presence of NF1 mutation or NF1 syndrome. If the STR has alleviated presenting symptoms, the patient is compliant with follow-up, and there are no radiographic and/or clinical concerns for visual or neurologic compromise, I would offer two options: adjuvant RT now, or active surveillance. Given that WHO gr. 1 craniopharyngiomas are typically ind...