Craniopharyngioma medical therapy: Difference between revisions

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{{Craniopharyngioma}}
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==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 ==
For treatment purposes, patients are grouped as having ''newly diagnosed'' or ''recurrent disease''.<ref>Rx of Craniopharyngioma. Cancer gov. http://www.cancer.gov/types/brain/hp/child-cranio-treatment-pdq#link/_40_toc</ref>
*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>
===Newly diagnosed craniopharyngioma===
*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>
There is no consensus on the optimal treatment for newly diagnosed craniopharyngioma, in part because of the lack of prospective randomized trials that compare the different treatment options. Treatment is individualized on the basis of factors that include the following:
*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>
#''Tumor size''
*[[Cyst|Cystic recurrences]] may be treated with [[Instillation abortion|intracavitary instillation]] of varying agents via [[stereotactic]] delivery or placement of an [[Catheter|Ommaya catheter]].
#''Tumor location''
*[[Stereotactic surgery|Stereotactic]] agents have included [[Radioactive tracer|radioactive P-32]] or other [[Radionuclide|radioactive compounds]], [[bleomycin]] or [[interferon-alpha]].
#''Extension of the tumor''
*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>
#''Potential short-term and long-term toxicity''
 
Treatment options for newly diagnosed craniopharyngioma include the following:
*'''Radical surgery with or without radiation therapy'''
**It is possible to remove all visible tumor and achieve long-term disease control because these tumors are histologically benign
**A 5-year progression-free survival (PFS) rate of about 65% has been reported
**Radical surgical approaches include the following:
***'''''Transsphenoidal approach''''': A transsphenoidal approach may be possible for some small tumors located entirely within the sella. The development of expanded ''endonasal techniques with endoscopic visualization'' have allowed this approach to be increasingly used, even for sizeable tumors.
***'''''Craniotomy''''': When an endonasal approach is not possible, a craniotomy is required. The surgeon often has a limited view of the hypothalamic and sellar regions, and portions of the mass may remain after surgery, accounting for some recurrences. Almost all craniopharyngiomas have an attachment to the pituitary stalk, and of the patients who undergo radical surgery, virtually all will require life-long pituitary hormone replacement with multiple medications.
 
*'''Subtotal resection with radiation therapy'''
*'''Primary cyst drainage with or without radiation therapy'''
 
===Recurrent craniopharyngioma===
*Surgery
*Radiation therapy, including radiosurgery
*Intracavitary instillation of radioactive P-32, bleomycin, or interferon-alpha, for those with cystic recurrences
*Systemic interferon


==References==
==References==
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Latest revision as of 04:30, 25 February 2019

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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

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


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