PURPOSE: We report the results of the early cohort of patients treated for 
craniopharyngioma with combined proton-photon irradiation at the Massachusetts 
General Hospital and the Harvard Cyclotron Laboratory.
METHODS AND MATERIALS: Between 1981 and 1988, 15 patients with craniopharyngioma 
were treated in part or entirely with fractionated 160 MeV proton beam therapy. 
The group consisted of 5 children (median age, 15.9 years) and 10 adults (median 
age, 36.2 years). Median dose prescribed to the tumor was 56.9 cobalt Gray 
equivalent (CGE; 1 proton Gray = 1.1 CGE). The median proton component was 26.9 
CGE. Patients were treated after documented recurrence after initial surgery (n 
= 6) or after subtotal resection or biopsy (n = 9). None had had prior radiation 
therapy.
RESULTS: Median observation period of surviving patients (n = 11) was 13.1 years 
from radiotherapy. One patient was lost to follow-up with tumor control after 
5.2 years. Actuarial 10-year survival rate was 72%. Four patients have died 
5-9.1 years after treatment, two from local failure. Actuarial 5- and 10-year 
local control rates were 93% and 85%, respectively. The functional status of the 
living adult patients is unaltered from their preradiotherapy status; all of 
them continued leading normal or near normal working lives. None of the patients 
treated as a child had experienced recurrence of tumor. One child shows learning 
difficulties and slight retardation, comparable to his preradiotherapy status. 
The others have professional achievements within the normal range.
CONCLUSION: Results in terms of survival and local control are comparable with 
other contemporary series. Although no formal neuropsychological testing was 
performed, the surrogate measures of lifestyle and professional accomplishments 
appear to be satisfactory.