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DOI: 10.1055/s-0034-1368785
Childhood Craniopharyngioma – Changes of Treatment Strategies in the Trials KRANIOPHARYNGEOM 2000/2007
Kraniopharyngeom im Kindes- und Jugendalter – Änderungen der Behandlungsstrategien im Rahmen der multizentrischen Studien KRANIOPHARYNGEOM 2000/2007Publication History
Publication Date:
12 May 2014 (online)
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Abstract
Background: Prognosis in childhood craniopharyngioma, is frequently impaired due to sequelae. Radical surgery was the treatment of choice for decades. Even at experienced facilities radical surgery can result in hypothalamic disorders such as severe obesity.
Objective: We analyzed, whether treatment strategies for childhood craniopharyngioma patients recruited in GPOH studies have changed during the last 12 years.
Materials and methods: We compared the grade of pre-surgical hypothalamic involvement, treatment, degree of resection and grade of surgical hypothalamic lesions between patients recruited in KRANIOPHARYNGEOM 2000 (n=120; 2001–2007) and KRANIOPHARYNGEOM 2007 (n=106; 2007–2012).
Results: The grade of initial hypothalamic involvement was similar in patients treated 2001–2007 and 2007–2012. The realized treatment was more radical (p=0.01) in patients recruited 2001–2007 (38%) when compared with patients treated 2007–2012 (18%). In patients with pre-surgical involvement of anterior/posterior hypothalamic areas, the rate of hypothalamus-sparing operations resulting in no (further) hypothalamic lesions was higher (p=0.005) in patients treated 2007–2012 (35%) in comparison with the 2001–2007 cohort (13%). Event-free-survival rates were similar in both cohorts.
Conclusions: A trend towards less radical surgical approaches is observed, which was accompanied by a reduced rate of severe hypothalamic lesions. Radical surgery is not an appropriate treatment strategy in patients with hypothalamic involvement. Despite previous recommendations to centralize treatment at specialized centers, a trend towards further decentralization was seen.
Zusammenfassung
Hintergrund: Die Prognose von Kindern und Jugendlichen mit Kraniopharyngeom wird durch Spätfolgen beeinträchtigt. Die radikale Resektion galt über Jahrzehnte als Therapie der Wahl. Allerdings drohen selbst bei Operation durch erfahrene neurochirurgische Teams hypothalamische Läsionen.
Fragestellung: Untersucht wurde, ob sich im Verlauf der Studien KRANIOPHARYNGEOM 2000/2007 Änderungen hinsichtlich der Behandlungsstrategie ergaben.
Patienten und Methoden: Verglichen wurden der Grad präoperativer hypothalamischer Beteiligung, operative Strategien, Resektionsgrad und Grad chirurgischer hypothalamischer Läsionen zwischen den Patientenkollektiven in KRANIOPHARYNGEOM 2000 [n=120; 2001–2007) und KRANIOPHARYNGEOM 2007 (n=106; 2007–2012).
Ergebnisse: Es bestanden keine Unterschiede hinsichtlich der präoperativen hypothalamischen Beteiligung zwischen beiden Studienkollektiven. Die Anzahl der radikalen Resektionen war höher (p=0.01) bei Patienten, die 2001–2007 rekrutiert wurden (38%), im Vergleich zum Rekrutierungszeitraum 2007–2012 (18%). Bei Risikopatienten mit präoperativer Beteiligung anteriorer/posteriorer hypothalamischer Areale resultierte im Rekrutierungszeitraum 2007–2012 eine schonendere operative Vorgehendweise in einer höheren Rate von Patienten ohne operative Läsionen (35%) im Vergleich zum Rekrutierungszeitraum 2001–2007 (13%). Die ereignisfreie Überlebensrate war in beiden Studien gleich.
Schlussfolgerungen: Im Vergleich der Studien zeigt sich in den letzten 12 Jahren ein Trend hin zu weniger radikalen chirurgischen Behandlungsstrategien mit Reduktion schwerer hypothalamischer Läsionen. Bei Kraniopharyngeomen mit hypothalamischer Beteiligung erscheint die radikale Resektion nicht empfehlenswert.
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