Craniopharyngioma medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Craniopharyngioma}} | {{Craniopharyngioma}} | ||
{{CMG}} | {{CMG}}{{AE}}{{Marjan}} | ||
==Overview== | ==Overview== | ||
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 == | ||
=== | *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> | ||
*[[ | *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 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> | |||
=== | *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> | ||
*[[ | *[[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== | ||
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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
- The mainstay of therapy for craniopharyngioma is surgery with or without radiation.[1]
- There are certain indications for medical therapy mostly in treating recurrent tumors.[2]
- The use of subcutaneous pegylated interferon alpha-2b to manage cystic recurrences can result in durable responses.[3]
- The chemotherapy drugs Paclitaxel and Carboplatin have shown a clinical significance in increasing the survival rate.[4]
- Cystic recurrences may be treated with intracavitary instillation of varying agents via stereotactic delivery or placement of an Ommaya catheter.
- Stereotactic agents have included radioactive P-32 or other radioactive compounds, bleomycin or interferon-alpha.
- None of these approaches have shown efficacy against solid portions of the tumor.[5] [6]
References
- ↑ 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.
- ↑ 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.
- ↑ Rx of Craniopharyngioma. Cancer gov. http://www.cancer.gov/types/brain/hp/child-cranio-treatment-pdq#link/_40_toc
- ↑ Petito CK, DeGirolami U, Earle KM (April 1976). "Craniopharyngiomas: a clinical and pathological review". Cancer. 37 (4): 1944–52. PMID 1260697.
- ↑ Rx of Craniopharyngioma. Cancer gov. http://www.cancer.gov/types/brain/hp/child-cranio-treatment-pdq#link/_40_toc
- ↑ Rx of Craniopharyngioma. Cancer gov. http://www.cancer.gov/types/brain/hp/child-cranio-treatment-pdq#link/_40_toc