Clinical outcome in children with craniopharyngioma treated with primary surgery and radiotherapy deferred until relapse

John A. Kalapurakal*, Stewart Goldman, Y. C. Hsieh, Tadanori Tomita, Maryanne Hoffman Marymont

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

109 Scopus citations

Abstract

Background. To report the clinical outcome in children with craniopharyngioma following primary surgery and deferred radiotherapy at relapse. Procedure. Twenty-five children with craniopharyngioma were treated with primary surgery. Total resection was achieved in 19 children (76%), while in 24% total resection was not achieved due to tumor adhesion to adjacent critical structures. None of these children received radiation therapy immediately after total or sub-total resection. Radiotherapy was delivered at the time of relapse in 11 patients (44%). Results. The median follow-up from primary surgery was 10 years (3-16 years). The 14 year overall survival was 100%. Tumor recurrence was observed in (12/25) 48% at a median interval of 17 months. Tumor recurrence following total resection was 6/19 (32%) compared to 100% (6/6) following sub-total resection, and radiotherapy. The 2, 3, and 6 years relapse-free survival following initial surgery was 72, 55, and 50%, respectively. Univariate analysis revealed only extent of surgery to be significant for local recurrence (P< 0.0001). The sequelae observed in these patients included panhypopituitarism (100%), appetite disorders and hypothalamic obesity (32%), neuropsychological and behavioral disorders (20%), and sleep disorders (12%). Majority of children with non-endocrine complications had a local recurrence requiring further surgery and radiotherapy. Conclusions. The two standard treatment options in children with craniopharyngioma are primary surgery and sub-total resection followed by radiotherapy. In certain subgroups of patients such as those with large tumors and hypothalamic extension, primary surgery is associated with a high incidence of complications and high failure rates. We recommend utilization of an individualized risk-based treatment approach, that attempts to maximize cure rates without compromising long-term functional outcome in children with craniopharyngiomas.

Original languageEnglish (US)
Pages (from-to)214-218
Number of pages5
JournalMedical and Pediatric Oncology
Volume40
Issue number4
DOIs
StatePublished - Apr 1 2003

Keywords

  • Brain tumor
  • Children
  • Craniopharyngioma
  • Local recurrence
  • Radiotherapy therapy
  • Stereotactic radiotherapy
  • Surgery

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Oncology
  • Cancer Research

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