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Updated: May 21, 2025
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Published on: February 6, 2019
Neuroendocrine Deficits and Weight Development Before and After Proton Therapy in Children With Craniopharyngioma
M Bischoff1, J Beckhaus2, D A Khalil3
1Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Centre (WTZ), 45147 Essen, Germany; Department of Radiation Oncology, Ruhr-University Bochum, Medical Faculty, Marien Hospital, Herne, Germany.
Insights
Paediatric craniopharyngioma patients often have panhypopituitarism before proton beam therapy (PBT). Weight gain primarily occurs before radiotherapy, indicating multifactorial endocrine issues requiring close monitoring.
Area of Science:
- Pediatric Oncology
- Endocrinology
- Radiation Oncology
Background:
- Craniopharyngioma is a common pediatric brain tumor affecting the pituitary gland.
- Endocrine morbidity and obesity are significant challenges in managing pediatric craniopharyngioma.
Purpose of the Study:
- To analyze factors influencing endocrine morbidity and obesity in pediatric craniopharyngioma patients undergoing proton beam therapy (PBT).
- To evaluate endocrine and obesity outcomes pre- and post-PBT.
Main Methods:
- Prospective registry study of 65 pediatric patients with craniopharyngioma starting PBT.
- Retrospective retrieval of endocrine deficits and BMI data prior to PBT.
- Calculation of cumulative incidences of endocrinopathies and BMI standard deviation scores (BMI-SDS).
Main Results:
- 90.8% of patients had at least one neuroendocrine deficit before PBT; 47.7% had panhypopituitarism.
- Postoperative diabetes insipidus correlated with higher rates of adrenocorticotropic hormone and thyroid-stimulating hormone deficiencies.
- Weight gain (BMI-SDS increase) was significantly greater before radiotherapy than during PBT (0.61 vs. 0.13).
- Hypothalamic involvement and diagnosis BMI-SDS were predictors of severe obesity at follow-up.
Conclusions:
- Panhypopituitarism is prevalent before PBT in pediatric craniopharyngioma.
- Early PBT may offer endocrine benefits, but requires longer follow-up for confirmation.
- Weight gain is most pronounced before radiotherapy, highlighting the multifactorial nature of endocrine dysfunction and obesity requiring diligent monitoring.
Aims:
Our objective was to analyse tumour- and treatment-related factors influencing endocrine morbidity and obesity pre- and post-proton beam therapy (PBT) in paediatric patients with craniopharyngioma.
Materials And Methods:
A total of 65 patients at the onset of PBT were included in the analysis within our prospective registry study. The data pertaining to endocrine deficits and BMI prior to PBT were retrieved from the medical records on a retrospective basis. Cumulative incidences (CI) of endocrinopathies, age- and sex-adjusted BMI standard deviation scores (BMI-SDS) were calculated.
Results:
Before PBT, 90.8% had ≥1 neuroendocrine deficit. Diabetes insipidus (DI) was attributed to surgery in 96%. Patients with postoperative DI had a higher 3-year CI of adrenocorticotropic hormone and thyroid-stimulating hormone deficiency rates compared to those without DI (p < .001). At PBT start, 47.7% had already panhypopituitarism compared to 67.7% at the last follow-up (FU). Median FU post-PBT was 3.2 years (range, 1.0-9.6). Post-PBT, 38.2% remained free of additional hormone deficiencies. A trend towards lower endocrine morbidity scores for patients who received PBT during their primary treatment compared to irradiation at progression did not reach statistical significance (p = .068). The BMI-SDS increase from diagnosis to the start of radiotherapy was significantly greater than from the start of PBT to the end of FU (mean BMI-SDS increase: 0.61, ±1.16 vs. 0.13, ±0.84, p = 0.019), with a median time of 10.2 and 38.4 months, respectively. In the multivariate analysis, hypothalamic involvement (p = .042) and the BMI-SDS level at diagnosis (p = .006) were identified as clinical factors indicating severe obesity at FU (BMI-SDS ≥+2).
Conclusions:
Panhypopituitarism is frequently observed in paediatric patients with craniopharyngioma prior to PBT. The potential benefits of early PBT on endocrine outcomes require further investigation through longer FU periods. The greatest increase in weight occurred before radiotherapy. Endocrine deficiencies and weight gain are multifactorial and require close monitoring.
