Craniopharyngioma medical therapy: Difference between revisions

Jump to navigation Jump to search
No edit summary
 
(13 intermediate revisions by 3 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Craniopharyngioma}}
{{Craniopharyngioma}}
{{CMG}}
{{CMG}}{{AE}}{{Marjan}}


==Overview==
==Overview==
Patients with craniopharyngioma have many treatment options. The selection depends on the size, location  of the tumor. The options are surgery, radiation therapy, chemotherapy, or a combination of these methods.
The predominant therapy for craniopharyngioma is [[Resection|surgical resection]]. [[Therapy|Adjunctive]] [[chemotherapy]] and [[radiation]] may be required. [[Subcutaneous tissue|Subcutaneous]] [[Pegylated interferon-alpha-2a|pegylated]] [[interferon]] [[Alpha-2B adrenergic receptor|alpha-2B]] has been used to treat [[Cyst|cystic]] recurrences. It can also be treated with [[Intracranial hemorrhage|intracavitary instillation]] of [[Radioactive isotopes|radioactive P-32,]] [[bleomycin]] or [[interferon-alpha]] via [[stereotactic]] delivery or placement of an [[Ommaya reservoir|Ommaya catheter]]. [[Paclitaxel]] and [[carboplatin]] have shown to prevent [[Recurrence plot|recurrence]] of [[Malignant|malignant craniopharyngiomas]]. [[Bleomycin|Intracavitary bleomycin]] reduces [[Cyst|cyst size]] and toughens and thickens the [[Cyst|cyst wall]], thereby facilitating [[Surgery|surgical excision]] of a [[Cyst|cyst membrane]] that otherwise might fragment at the time of open [[craniotomy]]. Reports of [[Bleomycin|intracystic bleomycin]] use are limited. Other agents like [[Interferon type I|interferon alpha]] are being tested in recent days.


==Medical Therapy==
==Medical Therapy ==
*Although the mainstay of therapy for craniopharyngioma is surgery with or without radiation, there are certain indications for medical therapy as well, mostly in treating recurrent tumors.
*The [[Therapy|mainstay of therapy]] for craniopharyngioma is [[surgery]] with or without [[Radiation therapy|radiation]].<ref name="pmid17630614">{{cite journal |vauthors=Garrè ML, Cama A |title=Craniopharyngioma: modern concepts in pathogenesis and treatment |journal=Curr. Opin. Pediatr. |volume=19 |issue=4 |pages=471–9 |date=August 2007 |pmid=17630614 |doi=10.1097/MOP.0b013e3282495a22 |url=}}</ref> 
*Although systemic therapy is generally not utilized, it has been shown that the use of '''subcutaneous pegylated [[interferon]] alpha-2b''' to manage ''cystic recurrences'' can result in durable responses.<ref>Rx of Craniopharyngioma. Cancer gov. http://www.cancer.gov/types/brain/hp/child-cranio-treatment-pdq#link/_40_toc</ref>
*There are certain [[Indications and usage|indications]] for [[Medical|medical therapy]] mostly in treating [[Tumors|recurrent tumors]].<ref name="pmid7885544">{{cite journal |vauthors=Weiner HL, Wisoff JH, Rosenberg ME, Kupersmith MJ, Cohen H, Zagzag D, Shiminski-Maher T, Flamm ES, Epstein FJ, Miller DC |title=Craniopharyngiomas: a clinicopathological analysis of factors predictive of recurrence and functional outcome |journal=Neurosurgery |volume=35 |issue=6 |pages=1001–10; discussion 1010–1 |date=December 1994 |pmid=7885544 |doi= |url=}}</ref>
*The chemotherapy drugs [[Paclitaxel]] and [[Carboplatin]] have shown a clinical (but not statistical) significance in increasing the survival rate in patients who've had gross total resections of their malignant tumors.
*The use of [[Subcutaneous tissue|subcutaneous]] [[Interferon-alpha|pegylated interferon alpha-2b]] to manage [[Cyst|cystic]] [[Recurrence period density entropy|recurrences]] can result in durable responses.<ref>Rx of Craniopharyngioma. Cancer gov. http://www.cancer.gov/types/brain/hp/child-cranio-treatment-pdq#link/_40_toc</ref>
*''Cystic recurrences'' may be treated with intracavitary instillation of varying agents via [[stereotactic]] delivery or placement of an Ommaya catheter. These agents have included radioactive P-32 or other radioactive compounds, [[bleomycin]] or [[interferon-alpha]]. These strategies have been found to be useful in certain cases, and a low risk of complications has been reported. However, none of these approaches have shown efficacy against solid portions of the tumor.<ref>Rx of Craniopharyngioma. Cancer gov. http://www.cancer.gov/types/brain/hp/child-cranio-treatment-pdq#link/_40_toc</ref>
*The [[Chemotherapy|chemotherapy drugs]] [[Paclitaxel]] and [[Carboplatin]] have shown a [[Significance|clinical significance]] in increasing the [[survival rate]].<ref name="pmid1260697">{{cite journal |vauthors=Petito CK, DeGirolami U, Earle KM |title=Craniopharyngiomas: a clinical and pathological review |journal=Cancer |volume=37 |issue=4 |pages=1944–52 |date=April 1976 |pmid=1260697 |doi= |url=}}</ref>
*The following is an example of a national and/or institutional ''phase II'' clinical trial that is currently being conducted. '''PBTC-039''' (NCT01964300) (''Peginterferon Alpha-2b'') in treating younger patients with craniopharyngioma that is recurrent or cannot be removed by surgery.<ref>Rx of Craniopharyngioma. Cancer gov. http://www.cancer.gov/types/brain/hp/child-cranio-treatment-pdq#link/_40_toc</ref>
*[[Cyst|Cystic recurrences]] may be treated with [[Instillation abortion|intracavitary instillation]] of varying agents via [[stereotactic]] delivery or placement of an [[Catheter|Ommaya catheter]].  
*[[Stereotactic surgery|Stereotactic]] agents have included [[Radioactive tracer|radioactive P-32]] or other [[Radionuclide|radioactive compounds]], [[bleomycin]] or [[interferon-alpha]].  
*None of these approaches have shown [[efficacy]] against [[Solid|solid portions]] of the [[tumor]].<ref>Rx of Craniopharyngioma. Cancer gov. http://www.cancer.gov/types/brain/hp/child-cranio-treatment-pdq#link/_40_toc</ref> <ref>Rx of Craniopharyngioma. Cancer gov. http://www.cancer.gov/types/brain/hp/child-cranio-treatment-pdq#link/_40_toc</ref>


==References==
==References==
Line 23: Line 25:
{{WikiDoc Help Menu}}
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
{{WikiDoc Sources}}
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Neurology]]
[[Category:Neurosurgery]]

Latest revision as of 04:30, 25 February 2019

Craniopharyngioma Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Craniopharyngioma from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Treatment

Medical Therapy

Surgery

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Craniopharyngioma medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Craniopharyngioma medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Craniopharyngioma medical therapy

CDC on Craniopharyngioma medical therapy

Craniopharyngioma medical therapy in the news

Blogs on Craniopharyngioma medical therapy

Directions to Hospitals Treating Craniopharyngioma

Risk calculators and risk factors for Craniopharyngioma medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Marjan Khan M.B.B.S.[2]

Overview

The predominant therapy for craniopharyngioma is surgical resection. Adjunctive chemotherapy and radiation may be required. Subcutaneous pegylated interferon alpha-2B has been used to treat cystic recurrences. It can also be treated with intracavitary instillation of radioactive P-32, bleomycin or interferon-alpha via stereotactic delivery or placement of an Ommaya catheter. Paclitaxel and carboplatin have shown to prevent recurrence of malignant craniopharyngiomas. Intracavitary bleomycin reduces cyst size and toughens and thickens the cyst wall, thereby facilitating surgical excision of a cyst membrane that otherwise might fragment at the time of open craniotomy. Reports of intracystic bleomycin use are limited. Other agents like interferon alpha are being tested in recent days.

Medical Therapy

References

  1. Garrè ML, Cama A (August 2007). "Craniopharyngioma: modern concepts in pathogenesis and treatment". Curr. Opin. Pediatr. 19 (4): 471–9. doi:10.1097/MOP.0b013e3282495a22. PMID 17630614.
  2. Weiner HL, Wisoff JH, Rosenberg ME, Kupersmith MJ, Cohen H, Zagzag D, Shiminski-Maher T, Flamm ES, Epstein FJ, Miller DC (December 1994). "Craniopharyngiomas: a clinicopathological analysis of factors predictive of recurrence and functional outcome". Neurosurgery. 35 (6): 1001–10, discussion 1010–1. PMID 7885544.
  3. Rx of Craniopharyngioma. Cancer gov. http://www.cancer.gov/types/brain/hp/child-cranio-treatment-pdq#link/_40_toc
  4. Petito CK, DeGirolami U, Earle KM (April 1976). "Craniopharyngiomas: a clinical and pathological review". Cancer. 37 (4): 1944–52. PMID 1260697.
  5. Rx of Craniopharyngioma. Cancer gov. http://www.cancer.gov/types/brain/hp/child-cranio-treatment-pdq#link/_40_toc
  6. Rx of Craniopharyngioma. Cancer gov. http://www.cancer.gov/types/brain/hp/child-cranio-treatment-pdq#link/_40_toc


Template:WikiDoc Sources