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Radical Resection Ups Survival With Craniopharyngioma


 

DENVER — Radical resection with initial curative intent provides the best chance of long-term, disease-free survival for pediatric patients with a craniopharyngioma, according to a follow-up study presented at a meeting on pediatric neurologic surgery.

Researchers retrospectively evaluated 80 consecutive pediatric patients who had a radical resection of a craniopharyngioma at New York University Medical Center. Gross total resection was achieved in 70 (87%) of the patients and a subtotal resection achieved in 10 (13%). All 55 of the children with a primary tumor had a gross total resection, compared with 15 (60%) of the 25 recurrent cancer group patients.

When an audience member commented: “I have a problem with starting with surgery in all children with a craniopharyngioma”, Dr. Kevin Hsieh replied: “We just analyzed all the postoperative patients during the last 21 years. As far as the decision-making process, this was not part of the study.”

Craniopharyngiomas are the most common nonglial tumor in pediatric patients, Dr. Hsieh said. An estimated 0.5–2 million such tumors occur each year. Surgical management of craniopharyngiomas continues to be controversial, specifically whether long-term outcomes are better with total resection versus partial resection and radiation therapy, according to Dr. Hsieh, of the department of neurosurgery at NYU Medical Center.

Not surprisingly, quality of life was better among those with a primary versus recurrent tumor. Also, “quality of life is reasonable and generally better among those with primary tumors that were successfully resected,” said Dr. Hsieh.

In addition, the primary craniopharyngioma group experienced lower mortality and recurrence rates, compared with the recurrent cancer group. There was no statistical difference in tumor size between the two groups.

Twelve patients died. There were two perioperative and two delayed deaths in the primary cancer group, compared with one perioperative and seven delayed deaths in the recurrent cancer group.

Among the children with primary tumors, 8 of 55 had a cancer recurrence. Among the 25 children initially treated for recurrence, 14 experienced a subsequent recurrence. There were few adverse events from the surgery if the child survived the first 2.5 years, judging from events during a mean follow-up of 7 years.

There was a total of 93 surgeries in the series. The average age at surgery was 10 years. An overwhelming majority of the patients, 77 of 80, required some endocrine replacement therapy after surgery. “The goal of treatment was radical resection of tumor through a transcranial approach,” Dr. Hsieh said at the meeting, which was jointly sponsored by the American Association of Neurological Surgeons and the Congress of Neurological Surgeons.

The researchers assessed survival using Kaplan-Meier curves. The 2.5-year actuarial survival rate was 0.86.

Radical resection for surgical cure has an excellent progression-free survival and overall survival, according to the investigators. They added that morbidity and quality of life are at least comparable to partial resection with radiation therapy. “Our philosophy is the best chance for long-term disease-free survival is to treat with curative intent up front,” Dr. Hsieh said.

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