Radiation-induced gliomas following radiotherapy for craniopharyngiomas: A case report and review of the literature

Enchev, Yavor; Ferdinandov, Dilyan; Kounin, Georgi; Encheva, Elitsa; Bussarsky, V.

doi:10.1016/j.clineuro.2009.03.009

Cited by 21 publications

(28 citation statements)

References 28 publications

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“…Side effects of radiotherapy include dysfunction of the hy pothalamicpituitary axis and visual apparatus, benign and malignant radiationinduced CNS tumors, cognitive and at tentional deficits, and cerebrovasculopathy/moyamoya dis ease. [5][6][7]26,28,29,31,36,37,41,51,52,60,63,64,72,75,84,87,88,90,96,97,102,105,106 These effects are more pronounced in younger children 64,75 and are correlated with increasing target volume and total dos age. 28,36,72,86,87 These late effects must be recognized when comparing risk-benefit profiles of radical versus limited resection and radiotherapy.…”

Section: Side Effects Of Radiation Therapy and Impact On Reoperationmentioning

confidence: 84%

Efficacy and safety of radical resection of primary and recurrent craniopharyngiomas in 86 children

Elliott¹,

Hsieh²,

Hochm

et al. 2010

PED

163

148

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Object Optimal treatment of primary and recurrent craniopharyngiomas remains controversial. Radical resection and limited resection plus radiation therapy yield similar rates of disease control and overall survival. The data are much less clear for recurrent tumors. The authors report their experience with radical resection of both primary and recurrent craniopharyngiomas in children and compare the outcomes between the 2 groups. Methods A retrospective analysis was performed in 86 children younger than 21 years of age who underwent a total of 103 operations for craniopharyngioma between 1986 and 2008; these were performed by the senior author. The goal was resection with curative intent in all patients. Two patients were lost to follow-up and were excluded from analysis. The mean age at the time of surgery was 9.6 years, and the mean follow-up was 9.0 years. Results All 57 children with primary tumors underwent gross-total resection (GTR). A GTR was achieved in significantly fewer children with recurrent tumors (18 [62%] of 29). There were 3 perioperative deaths (3%). Tumor recurred after GTR in 14 (20%) of 71 patients. Overall survival and progression-free survival were significantly better in patients with primary tumors at time of presentation to the authors' institution. There were no significant differences in the neurological, endocrinological, visual, or functional outcomes between patients with primary and those with recurrent tumors. Factors negatively affecting overall survival and progression-free survival include subtotal resection (recurrent tumors only), tumor size ≥ 5 cm, or presence of hydrocephalus or a ventriculoperitoneal shunt. Prior radiation therapy and increasing tumor size were both risk factors for incomplete resection at reoperation. Conclusions In the hands of surgeons with experience with craniopharyngiomas, the authors believe that radical resection at presentation offers the best chance of disease control and potential cure with acceptable morbidity. While GTR does not preclude recurrence and is more difficult to achieve in recurrent tumors, especially large and previously irradiated tumors, radical resection is still possible in patients with recurrent craniopharyngiomas with morbidity similar to that of primary tumors.

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Section: Side Effects Of Radiation Therapy and Impact On Reoperationmentioning

confidence: 84%

Efficacy and safety of radical resection of primary and recurrent craniopharyngiomas in 86 children

Elliott¹,

Hsieh²,

Hochm

et al. 2010

PED

163

148

View full text Add to dashboard Cite

show abstract

“…More pronounced in younger children, 41,42 side effects of RT include dysfunction of the hypothalamic-pituitary axis, vision decline, benign and malignant radiation-induced CNS tumors, cognitive dysfunction, attentional deficits, cerebrovasculopathy, and moyamoya disease. 1,2,16,18,19,24,36,40,45,60 Prior work by our group 20 and others 54 has shown significantly worse surgical outcomes and survival following tumor progression after failed RT. Given the 20-30% incidence of tumor progression following RT, 9 one must consider the potentially deleterious effects of early irradiation on the safety and efficacy of subsequent treatments.…”

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confidence: 99%

Craniopharyngioma Clinical Status Scale: a standardized metric of preoperative function and posttreatment outcome

Elliott¹,

Sands

Strom³

et al. 2010

FOC

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Object Controversy persists concerning the optimal treatment of craniopharyngiomas in children, and no standard outcome metric exists for comparison across treatment modalities, nor is there one that adequately reflects the multisystem dysfunction that may arise. Methods The authors retrospectively analyzed the records of 86 consecutive children who underwent a uniform treatment paradigm of attempted radical resection performed by a single surgeon. Excluding 3 perioperative deaths and 3 patients with inadequate follow-up, 80 children (34 girls and 46 boys; mean age 9.56 years; mean follow-up 9.6 years) composed the study group (53 primary and 27 previously treated/recurrent tumors). Building on existing classification schemes proposed by De Vile for hypothalamic dysfunction and Wen for overall functional outcome, the authors devised a more nuanced classification system (Craniopharyngioma Clinical Status Scale [CCSS]) that assesses outcome across 5 axes, including neurological examination, visual status, pituitary function, hypothalamic dysfunction, and educational/occupational status at last follow-up (there is a 4-tiered grading scale in each domain, with increasing values reflecting greater dysfunction). Results There was a significant increase in pituitary dysfunction following treatment—consistent with the high rates of diabetes insipidus and hypopituitarism common to the surgical management of craniopharyngiomas—and less dramatic deterioration in hypothalamic function or cognitive domains. Significant improvement in vision was also demonstrated, with no significant overall change in neurological status. Preoperative CCSS scores predicted postoperative outcome better than clinical characteristics like patient age, sex, tumor size, and the location or presence of hydrocephalus. Conclusions Preoperative CCSS scores predicted outcome with higher accuracy than clinical or imaging characteristics. In lieu of randomized trials, the CCSS may provide a useful outcome assessment tool for comparison across treatment paradigms and surgical approaches. Long-term follow-up is critical to the analysis of outcomes of craniopharyngioma treatment, given the often-delayed sequelae of all therapies and the high recurrence rates of these tumors.

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“…4 Multiple cases of postradiotherapy PNET were reported following initial diagnoses of pilocystic astrocytoma, ependymoma, and low-grade astrocytoma. 5,6,9 This is the first reported case of PNET after radiation therapy for the treatment of craniopharyngioma.…”

Section: Discussionmentioning

confidence: 99%

“…12 The case presented here meets all the requirements for a radiationinduced neoplasm as described by Cahan et al in 1948. 3,5 These criteria are: 1) tumor originating from areas that were previously irradiated; 2) elapsed time between radiation treatment and the appearance of the radiation-induced lesion; 3) no other pathological conditions that will predispose to tumor development; and 4) the histological characteristics must be different from those of the primary lesion that prompted the radiation treatment. 3,5 In our patient, the PNET was found in the field of irradiation almost 9 years after the initial treatment, and showed histopathological characteristics that were markedly different from those of the initial tumor.…”

Section: Discussionmentioning

confidence: 99%

Primitive neuroectodermal tumor after radiation therapy for craniopharyngioma

Chan

Herrera²,

Neckrysh³

et al. 2011

FOC

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The authors report a case of primitive neuroectodermal tumor induced by radiation therapy of craniopharyngioma. This African-American male patient originally presented with craniopharyngioma, for which he underwent resection and whole-brain radiation therapy. Eight years later, at the age of 20 years, he returned with a left facial droop and left hemiparesis. A right basal ganglia mass was identified and resected. Histopathological examination identified the lesion as primitive neuroectodermal tumor. Although radiation therapy has shown to be beneficial in decreasing the recurrence rate in subtotally resected craniopharyngioma, the risks of radiation treatment should be clearly communicated to the patients, their families, and neurosurgeons before starting such treatment. This report expands the spectrum of reported radiation-induced neoplasms in the CNS.

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Radiation-induced gliomas following radiotherapy for craniopharyngiomas: A case report and review of the literature

Cited by 21 publications

References 28 publications

Efficacy and safety of radical resection of primary and recurrent craniopharyngiomas in 86 children

Efficacy and safety of radical resection of primary and recurrent craniopharyngiomas in 86 children

Craniopharyngioma Clinical Status Scale: a standardized metric of preoperative function and posttreatment outcome

Primitive neuroectodermal tumor after radiation therapy for craniopharyngioma

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