Despite the statistical analysis showing poor correlation between radiation therapy and MT of craniopharyngiomas, we respectfully disagree with the conclusions of Sofela et al3 and Signorelli et al4 that radiation plays a minor role, if any, in the pathogenesis of malignant craniopharyngiomas. In addition to their series, there are 2 other cases (including our report) of MT that occurred after radiation therapy.5 In total, there are 16 cases of MT of craniopharyngioma related to previous radiation and 4 cases of MT with no radiation history. These numbers are still insufficient to find a statistically significant correlation. However, the difference in the number of cases with and without previous radiotherapy cannot be ignored based on the potential carcinogenesis effect of radiation and the rarity of this malignancy. We might be facing a type II statistical error due to a small sample size, leading us to wrong conclusions.
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