Interdisciplinary Neurosurgery (Sep 2022)
Paediatric craniopharyngiomas – Treatment outcomes based on when radiotherapy was given
Abstract
Introduction: Craniopharyngioma is a rare tumour arising in the suprasellar region with benign histology, but high morbidity and recurrence rate. Radiotherapy has been previously shown to reduce risk of local recurrence, but has its own inherent risk. The objective of this paper is to illustrate the management and progression of this disease in a population where radiotherapy was not usually offered as adjuvant to initial surgery. The two aims were to: (1) describe the population and treatment outcomes, and (2) conduct a subgroup analysis of patients based on radiotherapy status in the treatment received. Methods: Available records of patients who were histologically diagnosed with craniopharyngioma below the age of 17 were reviewed. Attributes of interest includes types of surgeries and timing of radiotherapy as well as BMI, hypothalamic function, pituitary function, and vision at diagnosis, during treatment and at long-term follow-up. Results: We identified 25 patients with a mean age of 100.20 ± 53.34 months at diagnosis. Subsequent intervention-free survival is similar between patients who had gross total resection (GTR) and patients who had adjuvant radiotherapy after primary surgery. There was no significant difference in BMI Z-score changes between patients who had different treatment regime nor the number of surgeries they had. In patients who had delayed radiotherapy, there was an increasing incidence of diabetes insipidus and pituitary dysfunction from after primary surgery to last follow-up, but this was not observed in the other groups. Conclusion: In our cohort, subsequent-intervention-free survival was similar between patients who had GTR and patients who had adjuvant radiotherapy after primary surgery. These patients who received delayed radiotherapy had similar outcomes to those who underwent GTR and those who had early radiotherapy.
