Endocrine outcome in long‐term survivors of low‐grade hypothalamic/chiasmatic glioma

Collett‐Solberg, Paulo Ferrez; Sernyak, Heidi; Satin-Smith, Marta; Katz, Lorraine Levitt; Sutton, Leslie N.; Molloy, Patricia T.; Moshang, Thomas

doi:10.1046/j.1365-2265.1997.2211032.x

Cited by 71 publications

(42 citation statements)

References 23 publications

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“…9,14,21,42 There are some suggestions that treatment-associated endocrinopathy is more significant with radiotherapy than chemotherapy or surgery, although not all authors agree. 9,21 For this cohort of patients, we plan to undertake a comprehensive cross-sectional neuropsychological and functional outcome study in the future.…”

Section: Outcomementioning

confidence: 99%

“…The rates of new or progressive endocrine deficit over the course of treatment are up to 64%. 5,9,11,14,26 It is clear that endocrine function is impaired initially by the tumor itself but is further impaired by the variety of treatment regimens employed to control the tumor. In this series, a mixture of precocious puberty and pituitary hormone deficiencies were evident at first presentation, before any treatment had been undertaken.…”

Section: Outcomementioning

confidence: 99%

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The role of surgery in optic pathway/hypothalamic gliomas in children

Goodden¹,

Pizer

Pettorini³

et al. 2014

PED

111

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Object Optic pathway/hypothalamic gliomas (OPHGs) are generally benign tumors situated in an exquisitely sensitive brain region. The location and natural history of OPHGs has led to much debate about optimal treatment. This paper revisits the role of and optimal timing of debulking surgery in OPHG. Methods This paper presents a series of cases managed by the neuro-oncology team at Alder Hey Children's Hospital and a single surgeon. Data were collected retrospectively for periods prior to 2009 and prospectively thereafter. Tailored treatment strategies were used, including observation and combinations of surgery, chemotherapy, and radiotherapy. Tumor control rates and outcomes are reviewed. Results Forty-two patients were treated between 1998 and 2011. Their median age at diagnosis was 5 years 7 months. Nineteen patients were positive for neurofibromatosis Type 1 (NF1) and 23 patients were negative for NF1. The median duration of follow-up was 77 months (range 21.8–142.3 months). Presenting symptoms included visual impairment (in 50% of cases), headache (in 24%), and hypothalamic/pituitary dysfunction (in 29%). Twenty-two debulking procedures were performed in 21 patients. Four biopsies (3 open, 1 endoscopic) were also performed. The histological diagnosis was pilocytic astrocytoma in 21 patients and pilomyxoid astrocytoma in 2 patients. Ten patients (Group 1) had primary surgical debulking alone and were then observed. Four patients (Group 2) had surgical debulking, plus planned chemotherapy within 3 months. Seven patients (Group 3) required surgical debulking for progressive disease following a variety of treatments. Patient age had the greatest impact on subsequent tumor progression. In total, 13 patients received chemotherapy, 4 on initial presentation, 4 in combination with surgery, and 5 for further tumor progression. Five patients were treated with radiotherapy, 3 prior to referral to Alder Hey. Eleven patients required shunt insertion for hydrocephalus. Vision was stabilized for 74% of patients. The number of patients with hypothalamic/pituitary dysfunction increased from 12 at presentation to 16 by the end of treatment. The overall survival rate was 93%. Three patients died—1 from tumor progression, 1 from infective complications from tumor biopsy, and 1 from a spontaneous posterior fossa hemorrhage. NF1 was associated with improved outcome—fewer patients required active intervention and rates of visual impairment and/or or hypothalamic/pituitary dysfunction were lower. Conclusions Good long-term survival and functional outcomes can be achieved in children with OPHG. Tumor control was achieved through an individualized approach using surgery, chemotherapy, or radiotherapy in varied combinations. The authors aim to limit radiotherapy to cases involving older children in whom other therapies have failed, due to the well-described and often devastating late effects associated with midline cranial irradiation. Surgery has a clear role for diagnosis, tumor control, and relief of mass effect. In particular, primary surgical debulking of tumor (without adjuvant therapy) is safe and effective. Recent advances in intraoperative MRI may add value and need further assessment.

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Section: Outcomementioning

confidence: 99%

Section: Outcomementioning

confidence: 99%

The role of surgery in optic pathway/hypothalamic gliomas in children

Goodden¹,

Pizer

Pettorini³

et al. 2014

PED

111

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“…3 Young children are more at risk for late effects of radiotherapy, including decrease in intellectual function, endocrine deficits, second neoplasms, hearing loss, and vasculopathy. [4][5][6][7][8][9] Because of these concerns, several groups have used chemotherapy to delay or replace radiotherapy in young children with tumors in critical locations not amenable to complete resection or when tumors progress after surgery or radiation. 10,11 When this trial was planned, the regimens that had previously been studied in LGGs were reviewed for their ability to produce objective responses and preliminary evidence of efficacy in controlling tumor regrowth.…”

Section: Introductionmentioning

confidence: 99%

Randomized Study of Two Chemotherapy Regimens for Treatment of Low-Grade Glioma in Young Children: A Report From the Children's Oncology Group

Ater

Zhou

Holmes

et al. 2012

JCO

382

303

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A B S T R A C T PurposeSurgery is curative therapy for pediatric low-grade gliomas (LGGs) in areas of the brain amenable to complete resection. However, LGGs located in areas where complete resection is not possible can threaten both function and life. The purpose of this study was to compare two chemotherapy regimens for LGGs in children younger than age 10 years for whom radiotherapy was felt by the practitioner to pose a high risk of neurodevelopmental injury. Patients and MethodsPreviously untreated children younger than age 10 years with progressive or residual LGGs were eligible. Children were randomly assigned to receive carboplatin and vincristine (CV) or thioguanine, procarbazine, lomustine, and vincristine (TPCV). Children with neurofibromatosis are reported separately. ResultsOf 274 randomly assigned patients who met eligibility requirements, 137 received CV and 137 received TPCV. The 5-year event-free survival (EFS) and overall survival (OS) rates for all eligible patients were 45% Ϯ 3.2% and 86% Ϯ 2.2%, respectively. The 5-year EFS rates were 39% Ϯ 4% for CV and 52% Ϯ 5% for TPCV (stratified log-rank test P ϭ .10; cure model analysis P ϭ .007). On multivariate analysis, factors independently predictive of worse EFS and OS were younger age and tumor size greater than 3 cm 2 . Tumor location in the thalamus was also associated with poor OS. ConclusionThe difference in EFS between the regimens did not reach significance on the basis of the stratified log-rank test. The 5-year EFS was higher for TPCV on the basis of the cure model analysis. Differences in toxicity may influence physician choice of regimens.

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“…У детей могут манифестировать задержкой роста и полового развития или преждевременным по-ловым созреванием. Иногда характеризуются такими неспеци фическими эндокринными нарушениями, как несахарный диабет и гиперпролактинемия [3].…”

Section: диагностикаunclassified

Объемные Образования Гипоталамической Области И Нарушения Центральной Регуляции Гомеостаза

Константиновна¹,

Aleksamdrovna²,

Viktorovna³

2014

Obes. metabol.

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Г ипоталамус принимает участие в регуляции раз-нообразных функций организма и формирова-нии моделей поведения. Нередко у пациентов с поражением гипоталамической области могут раз-виваться расстройства пищевого поведения -бу-лимия или анорексия. Уже в конце XIX в. Альфред Фрелих (Fröhlich) совместно с другими исследовате-лями описали ожирение, сочетающееся с бесплодием у пациентов с опухолями турецкого седла, -адипо-зогенитальная дистрофия, или синдром Фрелиха. Это состояние сопровождается избыточным накопле-нием подкожного жира, гипогонадотропным гипого-надизмом и задержкой роста. Позднее Гетерингтон и Рансон (Hetherington, Ranson) показали, что сте-реотаксическая деструкция медиального базального отдела гипоталамуса приводит к развитию патологи-ческого ожирения и нейроэндокринным расстрой-ствам, аналогичным синдрому Фрелиха. В настоящее время установлено, что фенотипы синдрома Фрелиха и синдромы вентромедиального повреждения гипо-таламуса, скорее всего, обусловлены дисфункцией или деструкцией ключевых гипоталамических ней-ронов, регулирующих секрецию гормонов гипофизом и энергетический гомеостаз. После открытия роли гипоталамических повреждений в развитии ожире-ния стало очевидным, что повреждения в других об-ластях, например латеральном гипоталамусе, могут вызвать афагию и тяжелую анорексию. Принято по-лагать, что центр питания расположен в латеральном гипоталамусе, а центр насыщения -в вентромедиаль-ном гипоталамусе. Таким образом, неоспорима роль гипоталамуса как интегратора и эффектора энерге-тического баланса и нейроэндокринной функции. Дисбаланс энергетического гомеостаза (как ожирение, так и кахексия) вследствие гипоталамической дис-функции может быть симптомом различных объемных образований гипоталамической области при опухоле-вых, гранулематозных, инфекционных заболеваниях, пороках развития и др., основные характеристики ко-торых представлены ниже. Дзеранова Л.К., Пигарова Е.А., Петрова Д.В.* Давно известно, что основные компоненты центрального контроля гомеостаза внутренней среды организма расположены в гипоталамусе. Гипоталамус участвует в регуляции множества функций организма и формировании моделей поведения, в том числе и пищевого. У пациентов с поражением гипоталамической области могут развиваться такие расстройства пищевого поведения, как булимия и анорексия. Дисбаланс энергетического гомеостаза (как ожирение, так и кахексия) вследствие гипоталамической дисфункции может быть симптомом различных объемных образований гипоталамической области, что требует проведения дифференциальной диагностики для определения подходов к лечению таких пациентов. Основные ха-рактеристики наиболее часто встречающихся объемных образований представлены в данной статье. It is well known that the main components of the central control of homeostasis of the internal environment are located in the hypothalamus. The hypothalamus is involved in the regulation of many body functions and formation of patterns of behavior, including food. Patients with lesions of the hypothalamic region may develop eating disorders such as bulim...

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Endocrine outcome in long‐term survivors of low‐grade hypothalamic/chiasmatic glioma

Cited by 71 publications

References 23 publications

The role of surgery in optic pathway/hypothalamic gliomas in children

The role of surgery in optic pathway/hypothalamic gliomas in children

Randomized Study of Two Chemotherapy Regimens for Treatment of Low-Grade Glioma in Young Children: A Report From the Children's Oncology Group

Объемные Образования Гипоталамической Области И Нарушения Центральной Регуляции Гомеостаза

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