Department of Neurological Sciences, Christian Medical College, Vellore, 632004, India.
Department of Pediatric Endocrinology, Christian Medical College, Vellore, India.
Childs Nerv Syst. 2022 Oct;38(10):1877-1883. doi: 10.1007/s00381-022-05635-z. Epub 2022 Aug 9.
Incomplete surgical removal of craniopharyngiomas frequently results in suboptimal oncological control. Radiation therapy is usually offered in these cases to prevent local recurrence of disease; however, the efficacy of radiation is limited by its potential adverse effect, particularly in younger patients. This study was undertaken to compare long-term outcomes and rates of postoperative obesity and endocrinopathy in patients undergoing either upfront adjuvant radiation after surgery, or postoperative surveillance with progression-contingent intervention.
Thirty-seven patients aged <25 years who had undergone primary incomplete surgical resection of craniopharyngiomas were retrospectively identified and categorized according to the prescribed treatment strategy. Recurrence rates, functional status, neuro-ophthalmologic, and endocrine outcomes were studied in both groups of patients.
Twenty-three patients received upfront adjuvant radiation, and 14 patients underwent postoperative surveillance. Adjuvant radiation in the former group was delivered using either conventional (n=10), 3D-conformal (n=4), or fractionated stereotactic (n=9) techniques using a linear accelerator. The mean follow-up duration was 64.7 months (range 14-134 months). Disease progression was significantly higher in patients undergoing surveillance as compared to those undergoing upfront adjuvant radiation (71.4 versus 17.4%; p=0.002). Median progression-free survival times were 129 months and 27 months in the upfront adjuvant radiation and surveillance groups, respectively (p=0.007). In patients undergoing surveillance, 50% ultimately required irradiation, and the median radiation-free survival time in this subgroup was 57 months. Two children in the adjuvant radiation group developed asymptomatic radiation-related vasculopathies on follow-up; however, there were no statistically significant differences between the two groups in terms of visual, functional, or pituitary-hypothalamic function at last follow-up.
In comparison to upfront adjuvant radiation following incomplete craniopharyngioma resection significantly, a strategy of postoperative surveillance resulted in less durable disease control but allowed radiation therapy to be delayed by a median time of 57 months, without significant detriment to global functional, visual, and neuro-endocrinological outcomes. The merits and demerits of either strategy should be carefully considered in the post-surgical management of these patients.
颅咽管瘤不完全切除常导致肿瘤控制不理想。在这些情况下，通常会提供放射治疗以防止疾病局部复发；然而，放射治疗的疗效受到其潜在不良反应的限制，尤其是在年轻患者中。本研究旨在比较行术后辅助放疗与术后监测并根据病情进展行干预的患者的长期预后和术后肥胖及内分泌并发症发生率。
回顾性分析了 37 名年龄<25 岁的患者，这些患者均因颅咽管瘤初次不完全手术切除后接受了治疗。研究人员比较了两组患者的复发率、功能状态、神经眼科和内分泌结果。
23 例患者接受了辅助放疗，14 例患者进行了术后监测。前者组的辅助放疗分别采用常规（n=10）、3D 适形（n=4）或分割立体定向（n=9）技术，使用直线加速器。平均随访时间为 64.7 个月（14-134 个月）。与行辅助放疗的患者相比，行术后监测的患者疾病进展率更高（71.4% vs. 17.4%；p=0.002）。行辅助放疗组和监测组的中位无进展生存期分别为 129 个月和 27 个月（p=0.007）。在监测组中，有 50%的患者最终需要接受放疗，该亚组的无放疗生存期中位数为 57 个月。在辅助放疗组中有 2 名儿童在随访中出现无症状的放疗相关血管病变，但两组在末次随访时的视力、功能或垂体-下丘脑功能方面无统计学差异。
与颅咽管瘤切除术后立即行辅助放疗相比，术后监测策略显著降低了疾病控制的持久性，但可将放疗推迟中位时间 57 个月，而不会对整体功能、视力和神经内分泌结果造成显著损害。在这些患者的术后管理中，应仔细考虑两种策略的利弊。
