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Craniopharyngioma in children
Y Khafaga1, D Jenkin, I Kanaan
1Department of Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
Insights
Pediatric craniopharyngioma treatment outcomes were analyzed. Postoperative irradiation after subtotal resection significantly improved progression-free survival in children, warranting further evaluation.
Area of Science:
- Pediatric Oncology
- Neurosurgery
- Radiation Oncology
Background:
- Craniopharyngioma is a rare brain tumor affecting children.
- Patients often present with advanced disease and significant morbidity.
Purpose of the Study:
- To analyze treatment regimens, morbidity, and survival rates for pediatric craniopharyngioma.
- To evaluate outcomes based on surgical extent and radiotherapy.
Main Methods:
- Retrospective review of 56 children treated between 1975-1996.
- Focus on 44 patients undergoing first definitive resection.
- Surgical approaches included total, subtotal, or lesser resections, with or without postoperative irradiation.
Main Results:
- Ten-year survival, progression-free, and event-free survival rates were 65%, 39%, and 29%, respectively.
- Patients with less than total resection without radiotherapy had no 5-year progression-free survival.
- Five irradiated patients after lesser resection remained progression-free.
Conclusions:
- Selective total resection and routine postoperative irradiation after subtotal resection need evaluation.
- Radiotherapy may be crucial for improving outcomes in pediatric craniopharyngioma.
Purpose:
The treatment regimens at presentation and recurrence, the related morbidity, and survival rates were studied for children with craniopharyngioma who were treated at King Faisal Specialist Hospital & Research Center (KFSH&RC).
Methods & Materials:
From 1975 to 1996, a total of 56 children younger than 18-years-old at diagnosis underwent treatment with surgery and/or radiotherapy for craniopharyngiomas at KFSH&RC. There was evidence that these patients had advanced disease at diagnosis; 36% of 51 patients whose visual status pretreatment was known were either blind or had major bilateral visual defects prior to treatment, and 36% of the 56 patients had diabetes insipidus. This report concentrates on 44 patients who had first definitive resection at KFSH&RC. Treatment policy was total resection if possible (17 patients), if not, subtotal resection (17 patients) or lesser procedures (10 patients). Five patients received postoperative irradiation after first definitive resection.
Results:
Ten-year-survival, and progression-free and event-free survival rates were 65%, 39%, and 29%, respectively. There were 9 postoperative deaths; 7 following the first procedure and 2 following resection for relapse, and 3 early deaths at home prior to relapse, following the first resection. None of the 22 patients who underwent less than total resection without postoperative radiation treatment were progression-free at 5 years, whereas the 5 patients who were irradiated remain progression-free.
Conclusion:
A more selective approach to total resection, and the routine use of postoperative irradiation following lesser surgical procedures requires evaluation.