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Global pediatric craniopharyngioma management modalities and outcomes
Alan R Tang1, Joseline Haizel-Cobbina2,3, Muhammad Usman Khalid4
1Vanderbilt University School of Medicine, TN, Nashville, USA.
Insights
Pediatric craniopharyngioma management is similar globally, though studies from low-income countries are lacking. This highlights a significant knowledge gap in understanding the full global burden of this childhood brain tumor.
Area of Science:
- Pediatric neuro-oncology
- Global health disparities in cancer care
Background:
- Craniopharyngioma is a complex pediatric brain tumor requiring multidisciplinary care.
- Limited global data exists comparing treatment modalities and outcomes across different regions.
- This systematic review addresses the need for a global comparison of pediatric craniopharyngioma management.
Approach:
- Systematic review adhering to PRISMA guidelines.
- Searched for studies on pediatric craniopharyngioma published between 2000-2022.
- Extracted and compared data on demographics, presentation, treatment, and outcomes based on country income level.
Key Points:
- No studies originated from low-income countries; most were from high-income nations.
- Similarities observed in patient demographics, presentation, tumor type, and surgical resection extent between high-income and middle-income countries.
- Differences noted in intracystic therapy agents (bleomycin in HICs vs. interferon in MICs) and radiation therapy (photon therapy in MICs).
Conclusions:
- Pediatric craniopharyngioma presentation and management appear consistent globally.
- A significant knowledge gap exists regarding craniopharyngioma in low-income and resource-poor regions.
- Further research is crucial to understand the complete global picture of pediatric craniopharyngioma.
Introduction:
Pediatric craniopharyngioma is a complex pathology, with optimal management involving a multidisciplinary approach and thoughtful care coordination. To date, no studies have compared various treatment modalities and outcomes described in different global regions. We conducted a comprehensive systematic review to compare demographics, clinical presentation, treatment approach and outcomes of children diagnosed with craniopharyngioma globally.
Methods:
A systematic review was conducted in accordance with the Preferred Reporting Item for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Search terms included "craniopharyngioma" and country-specific terms. Inclusion criteria included full-text studies published between 2000-2022, primarily examining pediatric patients 18-years old or younger diagnosed with craniopharyngioma, and reporting management and outcomes of interest. Data extracted included country of origin, demographical data, initial presentation and treatment modality, and outcomes. Descriptive statistics and between-group comparisons based on country of origin were performed.
Results:
Of 797 search results, 35 articles were included, mostly originating from high-income countries (HIC) (n = 25, 71.4%). No studies originated from low-income countries (LIC). When comparing HIC to middle-income countries (MIC), no differences in patient demographics were observed. No differences in symptomatology at initial presentation, tumor type, surgical approach or extent of surgical resection were observed. HIC patients undergoing intracystic therapy were more likely to receive bleomycin (n = 48, 85.7%), while the majority of MIC patients received interferon therapy (n = 10, 62.5%). All MIC patients undergoing radiation therapy underwent photon therapy (n = 102). No statistically significant differences were observed in postoperative complications or mean follow-up duration between HIC and MIC (78.1 ± 32.2 vs. 58.5 ± 32.1 months, p = 0.241).
Conclusion:
Pediatric craniopharyngioma presents and is managed similarly across the globe. However, no studies originating from LICs and resource-poor regions examine presentation and management to date, representing a significant knowledge gap that must be addressed to complete the global picture of pediatric craniopharyngioma burden and management.
