1
|
Poiset SJ, Song A, In Yoon H, Huang J, Jain S, Palmer JD, Matsui JK, Cappelli L, Mazza JM, Ali AS, Evans JJ, Farrell CJ, Kearns KN, Sheehan JP, Shi W. Long-Term Outcomes of Surgery and Radiation Treatment for Adult Patients with Craniopharyngioma. World Neurosurg 2024; 187:e852-e859. [PMID: 38719077 DOI: 10.1016/j.wneu.2024.04.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 04/30/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVE Treatment of craniopharyngioma typically entails gross total resection (GTR) or subtotal resection with adjuvant radiation (STR-RT). We analyzed outcomes in adults with craniopharyngioma undergoing GTR versus STR-RT. METHODS This retrospective study enrolled 115 patients with craniopharyngioma in 5 institutions. Patients with STR received postoperative RT with stereotactic radiosurgery or fractionated radiation therapy per institutional preference and ability to spare optic structures. RESULTS Median age was 44 years (range, 19-79 years). GTR was performed in 34 patients and STR-RT was performed in 81 patients with median follow-up of 78.9 months (range, 1-268 months). For GTR, local control was 90.5% at 2 years, 87.2% at 3 years, and 71.9% at 5 years. For STR-RT, local control was 93.6% at 2 years, 90.3% at 3 years, and 88.4% at 5 years. At 5 years following resection, there was no difference in local control (P = 0.08). Differences in rates of visual deterioration or panhypopituitarism were not observed between GTR and STR-RT groups. There was no difference in local control in adamantinomatous and papillary craniopharyngioma regardless of treatment. Additionally, worse local control was found in patients receiving STR-RT who were underdosed with fractionated radiation therapy (P = 0.03) or stereotactic radiosurgery (P = 0.04). CONCLUSIONS Good long-term control was achieved in adults with craniopharyngioma who underwent STR-RT or GTR with no significant difference in local control. First-line treatment for craniopharyngioma should continue to be maximal safe resection followed by RT as needed to balance optimal local control with long-term morbidity.
Collapse
Affiliation(s)
- Spencer J Poiset
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Andrew Song
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Hong In Yoon
- Department of Radiation Oncology, Yonsei University Health System, Seoul, South Korea
| | - Jiayi Huang
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Shray Jain
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Joshua D Palmer
- Department of Radiation Oncology, Ohio State University, Columbus, Ohio, USA
| | - Jennifer K Matsui
- Department of Radiation Oncology, Ohio State University, Columbus, Ohio, USA
| | - Louis Cappelli
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jacob M Mazza
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ayesha S Ali
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - James J Evans
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christopher J Farrell
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kathryn N Kearns
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Jason P Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Wenyin Shi
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
| |
Collapse
|
2
|
Zhang LY, Guo W, Du HZ, Pan H, Sun YC, Zhu HJ, Song SH, Guo XY, Jiang Y, Sun QQ. Brachytherapy in craniopharyngiomas: a systematic review and meta-analysis of long-term follow-up. BMC Cancer 2024; 24:637. [PMID: 38790011 PMCID: PMC11127349 DOI: 10.1186/s12885-024-12397-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 05/17/2024] [Indexed: 05/26/2024] Open
Abstract
OBJECTIVE Brachytherapy has been indicated as an alternative option for treating cystic craniopharyngiomas (CPs). The potential benefits of brachytherapy for CPs have not yet been clarified. The purpose of this work was to conduct a meta-analysis to analyze the long-term efficacy and adverse reactions profile of brachytherapy for CPs. MATERIALS AND METHODS The relevant databases were searched to collect the clinical trials on brachytherapy in patients with CPs. Included studies were limited to publications in full manuscript form with at least 5-year median follow-up, and adequate reporting of treatment outcomes and adverse reactions data. Stata 12.0 was used for data analysis. RESULTS According to the inclusion and exclusion criteria, a total of 6 clinical trials involving 266 patients with CPs were included in this meta-analysis. The minimum average follow-up was 5 years. The results of the meta-analysis showed that 1-year, 2-3 years and 5 years progression free survival rates (PFS) are 75% (95%CI: 66-84%), 62% (95%CI: 52-72%) and 57% (95%CI: 22-92%), respectively. At the last follow-up, less than 16% of patients with visual outcomes worser than baseline in all included studies. While, for endocrine outcomes, less than 32% of patients worser than baseline level. CONCLUSION In general, based on the above results, brachytherapy should be considered as a good choice for the treatment of CP.
Collapse
Affiliation(s)
- Li-Yuan Zhang
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Wei Guo
- Department of Radiation Oncology, Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine, Cangzhou Hebei, Hebei, 061000, China
| | - Han-Ze Du
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Hui Pan
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
| | - Yun-Chuan Sun
- Department of Radiation Oncology, Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine, Cangzhou Hebei, Hebei, 061000, China.
| | - Hui-Juan Zhu
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Shuai-Hua Song
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Xiao-Yuan Guo
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Yue Jiang
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Qian-Qian Sun
- Department of Endocrinology, The ninth Hospital of Xingtai, Xingtai, Hebei, 055250, China
| |
Collapse
|
3
|
Dias SF, Richards O, Elliot M, Chumas P. Pediatric-Like Brain Tumors in Adults. Adv Tech Stand Neurosurg 2024; 50:147-183. [PMID: 38592530 DOI: 10.1007/978-3-031-53578-9_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Pediatric brain tumors are different to those found in adults in pathological type, anatomical site, molecular signature, and probable tumor drivers. Although these tumors usually occur in childhood, they also rarely present in adult patients, either as a de novo diagnosis or as a delayed recurrence of a pediatric tumor in the setting of a patient that has transitioned into adult services.Due to the rarity of pediatric-like tumors in adults, the literature on these tumor types in adults is often limited to small case series, and treatment decisions are often based on the management plans taken from pediatric studies. However, the biology of these tumors is often different from the same tumors found in children. Likewise, adult patients are often unable to tolerate the side effects of the aggressive treatments used in children-for which there is little or no evidence of efficacy in adults. In this chapter, we review the literature and summarize the clinical, pathological, molecular profile, and response to treatment for the following pediatric tumor types-medulloblastoma, ependymoma, craniopharyngioma, pilocytic astrocytoma, subependymal giant cell astrocytoma, germ cell tumors, choroid plexus tumors, midline glioma, and pleomorphic xanthoastrocytoma-with emphasis on the differences to the adult population.
Collapse
Affiliation(s)
- Sandra Fernandes Dias
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Division of Pediatric Neurosurgery, University Children's Hospital of Zurich - Eleonor Foundation, Zurich, Switzerland
| | - Oliver Richards
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Martin Elliot
- Department of Paediatric Oncology and Haematology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Paul Chumas
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| |
Collapse
|
4
|
Gabay S, Merchant TE, Boop FA, Roth J, Constantini S. Shifting Strategies in the Treatment of Pediatric Craniopharyngioma. Curr Oncol Rep 2023; 25:1497-1513. [PMID: 38015373 DOI: 10.1007/s11912-023-01471-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE OF REVIEW Craniopharyngiomas represent one of the most challenging diseases to treat. Despite their benign histology, and after many decades of surgical experience and technological advancements, there is still no clear consensus regarding the most effective management for this tumor. Due to their location and aggressive local characteristics, purely surgical approaches all too often result in unacceptable morbidity. RECENT FINDINGS Partial resection combined with radiation therapy results in similar control rates when compared to aggressive surgery, while also minimalizing the neuro-endocrinological morbidity. In this manuscript, we describe the historical progression of the shifting strategies in the management of pediatric craniopharyngioma. Time has also altered our expectations for outcomes, evolving from purely morbidity and mortality to simple Glasgow Outcomes Scales, now to formal neuro-psychometric and quality of life data.
Collapse
Affiliation(s)
- Segev Gabay
- Department of Pediatric Neurosurgery and Pediatric Brain Institute, Dana Dwek Children Hospital, Tel Aviv Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel
| | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Frederick A Boop
- Department of Neurosurgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jonathan Roth
- Department of Pediatric Neurosurgery and Pediatric Brain Institute, Dana Dwek Children Hospital, Tel Aviv Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Constantini
- Department of Pediatric Neurosurgery and Pediatric Brain Institute, Dana Dwek Children Hospital, Tel Aviv Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel.
- Tel Aviv University, Tel Aviv, Israel.
| |
Collapse
|
5
|
Wu ZP, Wang YL, Wang LC, Liu ZY, Fan RR, Zan X, Liang RC, Yang JL, Zhou LX, Xu JG. Case Report: Successful Use of BRAF/MEK Inhibitors in Aggressive BRAF-mutant Craniopharyngioma. World Neurosurg 2023; 180:e117-e126. [PMID: 37683921 DOI: 10.1016/j.wneu.2023.08.137] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Although a benign intracranial tumor, craniopharyngioma treatment has always been considered a challenging clinical problem. Recently, BRAF V600E mutation in the pathogenesis of papillary craniopharyngioma (PCP) has been further revealed. Thus, BRAF inhibitors (BRAFi) serve as an applicable treatment for patients with PCP. METHODS Two patients with recurrent PCP were treated with combined BRAFi dabrafenib (150 mg, orally twice daily) and MEK inhibitors (MEKi) trametinib (2 mg, orally twice daily). A follow-up exceeding 2 years was conducted. We meticulously scrutinized the treatment's safety and efficacy profiles by delving into existing literature. RESULTS One patient harboring a solid tumor achieved a complete tumor response devoid of any adverse events and encountered no recurrence over 2 years subsequent to discontinuation. Moreover, within a mere month of commencing targeted therapy, the tumor demonstrated observable shrinkage. This finding substantiates the considerable potential inherent in targeted therapy for PCP cases marked by the somatic BRAF V600E mutation. CONCLUSIONS Under specific conditions, individuals diagnosed with PCP can attain a complete tumor response following combined treatment with BRAFi/MEKi.
Collapse
Affiliation(s)
- Ze-Pei Wu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yue-Long Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
| | - Li-Chong Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhi-Yong Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Rang-Rang Fan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Zan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Rui-Chao Liang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jin-Long Yang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Liang-Xue Zhou
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jian-Guo Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
6
|
Napieralska A, Mandera M, Sordyl R, Antosz A, Bekman B, Blamek S. The Price of Success-The Long-Term Outcomes of Children with Craniopharyngioma-Two Institutions' Experience. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1272. [PMID: 37508770 PMCID: PMC10378116 DOI: 10.3390/children10071272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023]
Abstract
An analysis of patients below 21 years old treated due to craniopharyngioma in the years 1979-2022 was performed with the aim of evaluating the long-term outcome and treatment side-effects. The standard statistical tests were used, and 56 patients with a median age of 11 years were evaluated. Surgery was the primary treatment in 55 patients; however, in only 29 it was the only neurosurgical intervention. Eighteen children were treated with radiotherapy (RTH) in primary treatment. The most common neurosurgical side effects observed were visual and endocrine deficits and obesity, which were diagnosed in 27 (49%), 50 (91%), and 25 (52%) patients, respectively. Complications after RTH were diagnosed in 14 cases (32%). During the median follow-up of 8.4 years (range: 0.4-39.8 years), six patients died and the 5- and 10-year overall survival was 97% and 93%, respectively. Five-year progression-free survival for gross total resection, resection with adjuvant RTH, and non-radical resection alone was 83%, 68%, and 23%, respectively (p = 0.0006). Surgery combined with RTH provides comparable results to gross tumor resection in terms of oncologic outcome in craniopharyngioma patients. Adjuvant irradiation applied in primary or salvage treatment improves disease control. The rate of complications is high irrespective of improved surgical and radiotherapeutic management.
Collapse
Affiliation(s)
- Aleksandra Napieralska
- Radiotherapy Department, MSC National Research Institute of Oncology Gliwice Branch, 44-101 Gliwice, Poland
| | - Marek Mandera
- Department of Pediatric Neurosurgery, Medical University of Silesia, 40-752 Katowice, Poland
| | - Ryszard Sordyl
- Department of Pediatric Neurosurgery, Medical University of Silesia, 40-752 Katowice, Poland
| | - Aleksandra Antosz
- Department of Pediatrics and Pediatric Endocrinology, Faculty of Medical Science, Medical University of Silesia, 40-752 Katowice, Poland
- Department of Pediatrics and Pediatric Endocrinology, Upper Silesian Medical Center in Katowice, 40-752 Katowice, Poland
| | - Barbara Bekman
- Radiotherapy and Brachytherapy Planning Department, MSC National Research Institute of Oncology Gliwice Branch, 44-101 Gliwice, Poland
| | - Sławomir Blamek
- Radiotherapy Department, MSC National Research Institute of Oncology Gliwice Branch, 44-101 Gliwice, Poland
| |
Collapse
|
7
|
Figueredo LF, Martínez AL, Suarez-Meade P, Marenco-Hillembrand L, Salazar AF, Pabon D, Guzmán J, Murguiondo-Perez R, Hallak H, Godo A, Sandoval-Garcia C, Ordoñez-Rubiano EG, Donaldson A, Chaichana KL, Peris-Celda M, Bendok BR, Samson SL, Quinones-Hinojosa A, Almeida JP. Current Role of Endoscopic Endonasal Approach for Craniopharyngiomas: A 10-Year Systematic Review and Meta-Analysis Comparison with the Open Transcranial Approach. Brain Sci 2023; 13:842. [PMID: 37371322 DOI: 10.3390/brainsci13060842] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 04/29/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023] Open
Abstract
In recent years, the endoscopic endonasal approach (EEA) for craniopharyngiomas has proven to be a safe option for extensive tumor resection, with minimal or no manipulation of the optic nerves and excellent visualization of the superior hypophyseal branches when compared to the Transcranial Approach (TCA). However, there is an ongoing debate regarding the criteria for selecting different approaches. To explore the current results of EEA and discuss its role in the management of craniopharyngiomas, we performed MEDLINE, Embase, and LILACS searches from 2012 to 2022. Baseline characteristics, the extent of resection, and clinical outcomes were evaluated. Statistical analysis was performed through an X2 and Fisher exact test, and a comparison between quantitative variables through a Kruskal-Wallis and verified with post hoc Bonferroni. The tumor volume was similar in both groups (EEA 11.92 cm3, -TCA 13.23 cm3). The mean follow-up in months was 39.9 for EEA and 43.94 for TCA, p = 0.76). The EEA group presented a higher visual improvement rate (41.96% vs. 25% for TCA, p < 0.0001, OR 7.7). Permanent DI was less frequent with EEA (29.20% vs. 67.40% for TCA, p < 0.0001, OR 0.2). CSF Leaks occurred more frequently with EEA (9.94% vs. 0.70% for TCA, p < 0.0001, OR 15.8). Recurrence rates were lower in the EEA group (EEA 15.50% vs. for TCA 21.20%, p = 0.04, OR 0.7). Our results demonstrate that, in selected cases, EEA for resection of craniopharyngiomas is associated with better results regarding visual preservation and extent of tumor resection. Postoperative CSF leak rates associated with EEA have improved compared to the historical series. The decision-making process should consider each person's characteristics; however, it is noticeable that recent data regarding EEA justify its widespread application as a first-line approach in centers of excellence for skull base surgery.
Collapse
Affiliation(s)
- Luisa F Figueredo
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Andrea L Martínez
- Faculty of Medicine, Universidad de Los Andes, Bogotá 111711, Colombia
| | - Paola Suarez-Meade
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | | | - Daniela Pabon
- Faculty of Medicine, Universidad de Los Andes, Bogotá 111711, Colombia
| | - Juan Guzmán
- Faculty of Medicine, Universidad de Los Andes, Bogotá 111711, Colombia
| | | | - Hana Hallak
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN 55901, USA
| | - Alex Godo
- Faculty of Medicine, Universitat Pompeu Fabra & Universitat Autònoma de Barcelona, 08002 Barcelona, Spain
| | | | - Edgar G Ordoñez-Rubiano
- Department of Neurological Surgery, Fundación Universitaria de las Ciencias de la Salud, Hospital de San José-Sociedad de Cirugía de Bogotá, Bogotá 111711, Colombia
| | - Angela Donaldson
- Department of Otolaryngology (ENT), Head and Neck Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Kaisorn L Chaichana
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | - María Peris-Celda
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN 55901, USA
| | - Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Susan L Samson
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
- Department of Internal Medicine, Division of Endocrinology, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | - Joao Paulo Almeida
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| |
Collapse
|
8
|
Grossman A, Kosmin M. Craniopharyngiomas and proton beam therapy: worth the expense? Lancet Oncol 2023; 24:422-423. [PMID: 37084749 DOI: 10.1016/s1470-2045(23)00162-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/05/2023] [Accepted: 04/05/2023] [Indexed: 04/23/2023]
Affiliation(s)
- Ashley Grossman
- Barts and the London School of Medicine, University of London, London, UK; Green Templeton College, University of Oxford, Oxford, UK.
| | - Michael Kosmin
- Department of Radiotherapy, University College London Hospitals NHS Foundation Trust, London, UK
| |
Collapse
|
9
|
Beddok A, Scher N, Alapetite C, Baussart B, Bentahila G, Bielle F, Bolle S, Dendale R, Dureau S, Goudjl F, Helfre S, Mammar H, Nichelli L, Calugaru V, Feuvret L. Proton therapy for adult craniopharyngioma: Experience of a single institution in 91 consecutive patients. Neuro Oncol 2023; 25:710-719. [PMID: 36002321 PMCID: PMC10076942 DOI: 10.1093/neuonc/noac210] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Craniopharyngioma (CP) in adults is a rare benign tumor associated with many morbidities, with limited contemporary studies to define treatment, and follow-up guidelines. METHODS A single-center retrospective study was conducted on patients aged ≥ 18 years from 2006-2018 with CP and who were treated with proton therapy (PT). Late toxicity was defined as a minimum of 18 months from diagnosis. Overall survival (OS), local recurrence-free survival (LRFS), and toxicity were characterized using Kaplan-Meier and Cox regression analyses. RESULTS Ninety-one patients met the criteria, with a median age of 37 years (range 18-82 years). PT was conducted after tumor resection in 88 patients (97%), in 64 patients (70.3%) as an adjuvant strategy and in 27 (29.7%) after recurrent disease. Three patients received exclusive PT. A median MRI follow-up of 39 months revealed 35.2% complete response, 49.5% partial response, and 9.9% stable disease. Five patients developed local recurrence (LR). The pattern of failure study showed that these five LR were within the GTV volume. The 5-year LRFS was 92.0% [CI 95% 84.90-99.60]. All the patients were alive at the end of the follow-up. Patients requiring treatment adaptation during PT tend to have a higher risk of LR (P = .084). Endocrinopathy was the most frequent grade ≥ 2 late toxicity. Among patients who were symptom-free before the start of treatment, none developed hearing toxicity but four (9.8%) developed visual disorders and 10 (11.3%) symptomatic memory impairment. Patients with large tumors had a higher risk of developing symptomatic memory impairment (P = .029). CONCLUSION Adults with CP treated with PT have favorable survival outcomes, with acceptable late toxicity. Prospective quality-of-life and neurocognitive studies are needed to define late adverse effects better.
Collapse
Affiliation(s)
- Arnaud Beddok
- Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, Centre Universitaire, 91898 Orsay, France
- Institut Curie, PSL Research University, University Paris Saclay, Inserm LITO, 91898 Orsay, France
| | - Nathaniel Scher
- Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, Centre Universitaire, 91898 Orsay, France
- Hartmann Oncology Radiotherapy Group, 4 Rue Kleber, 92309 Levallois-Perret, France
| | - Claire Alapetite
- Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, Centre Universitaire, 91898 Orsay, France
| | - Bertrand Baussart
- Department of Neurosurgery, Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière, Charles Foix, Paris, France
| | - Ghita Bentahila
- Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, Centre Universitaire, 91898 Orsay, France
| | - Franck Bielle
- Department of Neuropathology, Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière, Charles Foix, Paris, France
| | - Stephanie Bolle
- Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, Centre Universitaire, 91898 Orsay, France
- Department of Radiation Oncology, Gustave Roussy, Villejuif, Paris, France
| | - Remi Dendale
- Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, Centre Universitaire, 91898 Orsay, France
| | - Sylvain Dureau
- Department of statistics, Institut Curie, Saint-Cloud, France
| | - Farid Goudjl
- Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, Centre Universitaire, 91898 Orsay, France
| | - Sylvie Helfre
- Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, Centre Universitaire, 91898 Orsay, France
| | - Hamid Mammar
- Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, Centre Universitaire, 91898 Orsay, France
| | - Lucia Nichelli
- Department of Neuroradiology, Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière, Charles Foix, Paris, France
| | - Valentin Calugaru
- Institut Curie, PSL Research University, Radiation Oncology Department, Proton Therapy Centre, Centre Universitaire, 91898 Orsay, France
| | - Loïc Feuvret
- Department of Radiation Oncology, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière, Charles Foix, Sorbonne Université, Paris, France
- Department of Radiation Therapy, East Group Hospital, Hospices Civils de Lyon, Lyon, France
| |
Collapse
|
10
|
Jannelli G, Calvanese F, Paun L, Raverot G, Jouanneau E. Current Advances in Papillary Craniopharyngioma: State-Of-The-Art Therapies and Overview of the Literature. Brain Sci 2023; 13:515. [PMID: 36979325 PMCID: PMC10046497 DOI: 10.3390/brainsci13030515] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/13/2023] [Accepted: 03/18/2023] [Indexed: 03/30/2023] Open
Abstract
Craniopharyngiomas are commonly classified as low-grade tumors, although they may harbor a malignant behavior due to their high rate of recurrence and long-term morbidity. Craniopharyngiomas are classically distinguished into two histological types (adamantinomatous and papillary), which have been recently considered by the WHO classification of CNS tumors as two independent entities, due to different epidemiological, radiological, histopathological, and genetic patterns. With regard to papillary craniopharyngioma, a BRAF V600 mutation is detected in 95% of cases. This genetic feature is opening new frontiers in the treatment of these tumors using an adjuvant or, in selected cases, a neo-adjuvant approach. In this article, we present an overview of the more recent literature, focusing on the specificities and the role of oncological treatment in the management of papillary craniopharyngiomas. Based on our research and experience, we strongly suggest a multimodal approach combining clinical, endocrinological, radiological, histological, and oncological findings in both preoperative workup and postoperative follow up to define a roadmap integrating every aspect of this challenging condition.
Collapse
Affiliation(s)
- Gianpaolo Jannelli
- Skull Base and Pituitary Unit, Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, Bron, 69677 Lyon, France; (G.J.)
- Neurosurgical Unit, Faculty of Medicine, Geneva University Hospitals, University of Geneva, 1205 Geneva, Switzerland
| | - Francesco Calvanese
- Skull Base and Pituitary Unit, Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, Bron, 69677 Lyon, France; (G.J.)
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki University, Meilahden tornisairaala, Haartmaninkatu 4 Rakennus 1, 00290 Helsinki, Finland
| | - Luca Paun
- Neurosurgical Unit, Faculty of Medicine, Geneva University Hospitals, University of Geneva, 1205 Geneva, Switzerland
- Department of Neurosurgery, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, 1 Rue Cabanis, CEDEX 14, 75014 Paris, France
| | - Gerald Raverot
- Department of Endocrinology, Neurological Hospital Pierre Wertheimer, University Hospital of Lyon, 69500 Lyon, France
- Inserm U1052, CNRS UMR5286, Cancer Research Center of Lyon, University Claude Bernard Lyon 1, 69000 Lyon, France
| | - Emmanuel Jouanneau
- Skull Base and Pituitary Unit, Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, Bron, 69677 Lyon, France; (G.J.)
- Inserm U1052, CNRS UMR5286, Cancer Research Center of Lyon, University Claude Bernard Lyon 1, 69000 Lyon, France
| |
Collapse
|
11
|
Dogra P, Bedatsova L, Van Gompel JJ, Giannini C, Donegan DM, Erickson D. Long-term outcomes in patients with adult-onset craniopharyngioma. Endocrine 2022; 78:123-134. [PMID: 35869972 PMCID: PMC9308022 DOI: 10.1007/s12020-022-03134-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/01/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Craniopharyngiomas are nonmalignant sellar and parasellar tumors exhibiting a bimodal age distribution. While the outcomes following treatment in patients with childhood-onset craniopharyngiomas are well characterized, similar information in adult-onset craniopharyngiomas is limited. We aimed to describe the long-term outcomes (weight and metabolic parameters, mortality) in patients with adult-onset craniopharyngioma following treatment. METHODS Patients with adult-onset craniopharyngioma with initial treatment (1993-2017) and >6 months of follow-up at our institution were retrospectively identified. Body mass index (BMI) categories included obese (BMI ≥ 30 kg/m2), overweight (BMI 25-29.9 kg/m2), and normal weight (BMI < 25 kg/m2). RESULTS For the 91 patients with adult-onset craniopharyngioma (44% women, mean diagnosis age 48.2 ± 18 years) over a mean follow-up of 100.3 ± 69.5 months, weight at last follow-up was significantly higher than before surgery (mean difference 9.5 ± 14.8 kg, P < 0.001) with a higher percentage increase in weight seen in those with lower preoperative BMI (normal weight (20.7 ± 18%) vs. overweight (13.3 ± 18.0%) vs. obese (6.4 ± 15%), P = 0.012). At last follow-up, the prevalence of obesity (62 vs. 40.5%, P = 0.0042) and impaired glucose metabolism (17.4% vs. 34%, P = 0.017) increased significantly. All-cause mortality was 12%, with the average age of death 71.9 ± 19.7 years (average U.S. life expectancy 77.7 years, CDC 2020). CONCLUSION Patients with adult-onset craniopharyngioma following treatment may experience weight gain, increased prevalence of obesity, impaired glucose metabolism, and early mortality. Lower preoperative BMI is associated with a greater percentage increase in postoperative weight.
Collapse
Affiliation(s)
- Prerna Dogra
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Lucia Bedatsova
- Department of Internal Medicine, Hôpital Neuchâtelois, Neuchâtel, Switzerland
| | - Jamie J Van Gompel
- Departments of Neurosurgery and Otolaryngology, Mayo Clinic, Rochester, MN, USA
| | - Caterina Giannini
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Diane M Donegan
- Division of Endocrinology, Diabetes, and Metabolism, Indiana University, Indianapolis, IN, USA
| | - Dana Erickson
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
12
|
Abstract
Craniopharyngioma (CP) is an intracranial benign tumor that behaves aggressively due to its location, infiltration of the surrounding nervous tissue and high capacity for recurrence. Treatment of choice is surgery followed or not by radiotherapy. Recent advances in molecular biology techniques and the better understanding of the genetic alterations of the two histological types of CP have open new therapeutic perspectives with targeted drugs. Adamantinomatous CP (ACP) is associated with activating mutations of the CTNNB1 gene. Such mutations are accompanied by intracellular accumulation of β-catenin, an oncogenic protein that activates the intracellular Wnt/ β-catenin signaling pathway, which regulates the transcription of genes involved in cell proliferation. Therefore, the use of molecular therapies directed against the activation of the Wnt/ β-catenin pathway could be an attractive and promising therapeutic option in the management of ACPs. On the other hand, papillary CP (PCP) is associated with activating mutations in the BRAF gene. This gene encodes a BRAF protein that plays an important role in the intracellular mitogen-activated protein kinase (MAPK) signaling pathway, which also regulates cell proliferation. The use of BRAF inhibitors either in monotherapy or in combination with mitogen-activated protein kinase (MEK) inhibitors has demonstrated therapeutic efficacy in isolated clinical cases of relapsed PCPs. A preliminary report of a recent phase II clinical trial has shown a therapeutic response in 93.7% of patients with BRAF V600E -mutated PCP, with an 85% reduction in tumor size. In the present review we comment on the efficacy and safety of the different drugs being used in patients with PCP.
Collapse
Affiliation(s)
- Pedro Iglesias
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana (IDIPHISA), Calle Manuel de Falla 1, 28222, Madrid, Spain.
| |
Collapse
|
13
|
Alexandraki KI, Xekouki P. Medical Therapy for Craniopharyngiomas. TOUCHREVIEWS IN ENDOCRINOLOGY 2022; 17:121-132. [PMID: 35118458 DOI: 10.17925/ee.2021.17.2.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/01/2021] [Indexed: 11/24/2022]
Abstract
Craniopharyngiomas are rare benign neoplasms presenting in two different types, adamantinomatous (ACP) or papillary (PCP), which are molecularly and clinically distinct. Traditional treatment includes surgical resection and radiotherapy, which are accompanied by a number of debilitating complications because of the tumours' proximity to important brain structures. Recent advances in the understanding of molecular pathogenesis of craniopharyngiomas have opened horizons to medical therapeutic options. ACPs are mainly characterized by mutations of β-catenin, which activate Wingless/Int (Wnt), and alter the mitogen extracellular kinase (MEK)/extracellular signal-regulated kinase (ERK) pathway, as well as inflammatory, cellular senescence, programmed cell death and sonic hedgehog (SHH) pathways. PCPs are mainly characterized by Ras/Raf/MEK/ERK pathway activation secondary to BRAF-V600E mutations. MEK inhibitors, such as binimetinib, or anti-inflammatory mediators, such as tocilizumab or interferon, have been administered to patients with ACP and the efficacy is mostly favourable. On the other hand, BRAF inhibitors, such as dabrafenib or vemurafenib, either alone or in combination with the MEK inhibitors trametinib and cobimetinib, have been administered to patients with PCP resulting in favourable responses. A number of ongoing trials will shed light on schemes, doses, combined treatments and safety issues of the new molecular-targeted treatments, changing the management of patients with craniopharyngiomas by launching the era of personalized medicine in these rare neoplasms. We conducted a systematic review to identify case series or case reports with patients currently treated with systemic medical therapy.
Collapse
Affiliation(s)
- Krystallenia I Alexandraki
- Second Department of Surgery, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Paraskevi Xekouki
- Endocrinology and Diabetes Clinic, University General Hospital of Heraklion, University of Crete School of Medicine, Heraklion, Greece
| |
Collapse
|
14
|
Bereket A. Postoperative and Long-Term Endocrinologic Complications of Craniopharyngioma. Horm Res Paediatr 2022; 93:497-509. [PMID: 33794526 DOI: 10.1159/000515347] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/18/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Craniopharyngioma (CP), despite being a malformational tumor of low histological grade, causes considerable morbidity and mortality mostly due to hypothalamo-pituitary dysfunction that is created by tumor itself or its treatment. SUMMARY Fluid-electrolyte disturbances which range from dehydration to fluid overload and from hypernatremia to hyponatremia are frequently encountered during the acute postoperative period and should be carefully managed to avoid permanent neurological sequelae. Hypopituitarism, increased cardiovascular risk, hypothalamic damage, hypothalamic obesity, visual and neurological deficits, and impaired bone health and cognitive function are the morbidities affecting the well-being of these patients in the long term. Key Messages: Timely and optimal treatment of early postoperative and long-term complications of CP is crucial for preserving quality of life of these patients.
Collapse
Affiliation(s)
- Abdullah Bereket
- Division of Pediatric Endocrinology, Department of Pediatrics, School of Medicine, Marmara University, Istanbul, Turkey
| |
Collapse
|
15
|
Brachytherapy in paediatric craniopharyngiomas: a systematic review and meta-analysis of recent literature. Childs Nerv Syst 2022; 38:253-262. [PMID: 34618201 DOI: 10.1007/s00381-021-05378-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/27/2021] [Indexed: 12/17/2022]
Abstract
PURPOSES Brachytherapy has been indicated as an alternative option for treating cystic craniopharyngiomas. Despite the difficulties regarding the complex nuclear infrastructure and consequent small number of brachytherapy studies, recent discoveries relating tumour characteristics to sensitivity to brachytherapy have stimulated this extensive systematic review and meta-analysis of the recent results aiming to summarise its efficacy and complications. METHODS The systematic review was structured using PRISMA statements. The MEDLINE database was systematically reviewed from March 2010 to February 2021 to identify qualified trials dealing with radioisotope brachytherapy in cystic craniopharyngiomas in the paediatric population, emphasising tumour control rates and complications. RESULTS A total of 228 individuals were analysed, of which 66 were children. The minimum average follow-up was 5 years. Considering the paediatric trials, partial and complete responses were achieved in 89% of patients with exclusively cystic lesions, compared to 58% in non-exclusively cystic lesions. The former observed progression in 3% of patients, while in the latter, 35% was reported. Visual and endocrine improvement reached 64% and 20%, respectively, in the first group, in contrast to 48% and 7% in the second group, respectively. There were similar results considering the non-exclusive paediatric series, but with less expressive numbers. CONCLUSION These results reinforce the positive impact of radioisotope brachytherapy in the treatment of predominant monocystic or multicystic craniopharyngiomas, especially in the paediatric population, grounded by impressive tumour control rates, lower morbidities and single application in the majority of the cases. In the future, specific morphological tumour characteristics might be considered for a more assertive patient selection.
Collapse
|
16
|
Calvanese F, Jacquesson T, Manet R, Vasiljevic A, Lasolle H, Ducray F, Raverot G, Jouanneau E. Neoadjuvant B-RAF and MEK Inhibitor Targeted Therapy for Adult Papillary Craniopharyngiomas: A New Treatment Paradigm. Front Endocrinol (Lausanne) 2022; 13:882381. [PMID: 35757402 PMCID: PMC9228029 DOI: 10.3389/fendo.2022.882381] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/04/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Surgical and clinical management of craniopharyngiomas is associated with high long-term morbidity especially in the case of hypothalamic involvement. Improvements in knowledge of craniopharyngioma molecular biology may offer the possibility of safe and effective medical neoadjuvant treatments in a subset of patients harboring papillary subtype tumors with a BRAFV600E mutation. METHOD We report herein two cases of tubero-infundibular and ventricular Papillary Craniopharyngiomas in which BRAF/MEK inhibitor combined therapy was used as adjuvant (Case 1) or neoadjuvant (Case 2) treatment, with a 90% reduction in tumor volume observed after only 5 months. In Case 2 the only surgical procedure used was a minimal invasive biopsy by the trans-ventricular neuroendoscopic approach. As a consequence, targeted therapy was administered in purely neoadjuvant fashion. After shrinkage of the tumor, both patients underwent fractionated radiotherapy on the small tumor remnant to achieve long-term tumor control. A review of a previously reported case has also been performed. RESULT This approach led to tumor control with minimal long-term morbidity in both cases. No side effects or complications were reported after medical treatment and adjuvant radiotherapy. CONCLUSION Our experience and a review of the literature argue for a change in the current treatment paradigm for Craniopharyngiomas (CPs). In giant and invasive tumors, confirmation of BRAFV600E mutated PCPs by biopsy and BRAF/MEK inhibitor therapy before proposing other treatments may be useful to improve long term outcomes for patients.
Collapse
Affiliation(s)
- Francesco Calvanese
- Pituitary and Skull Base Neurosurgical Department, Reference Center for Rare Pituitary Diseases HYPO, “Groupement Hospitalier Est” Hospices Civils de Lyon, “Claude Bernard” Lyon 1 University, Hôpital Pierre Wertheimer, Lyon, France
- Department of Neurosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
- *Correspondence: Francesco Calvanese, ; orcid.org/0000-0002-0966-2487
| | - Timothée Jacquesson
- Pituitary and Skull Base Neurosurgical Department, Reference Center for Rare Pituitary Diseases HYPO, “Groupement Hospitalier Est” Hospices Civils de Lyon, “Claude Bernard” Lyon 1 University, Hôpital Pierre Wertheimer, Lyon, France
- Lyon University, Université Claude Bernard Lyon 1, Lyon, France
- CREATIS Laboratory CNRS UMR5220, Inserm U1206, INSA-Lyon, University of Lyon 1, Lyon, France
| | - Romain Manet
- Pituitary and Skull Base Neurosurgical Department, Reference Center for Rare Pituitary Diseases HYPO, “Groupement Hospitalier Est” Hospices Civils de Lyon, “Claude Bernard” Lyon 1 University, Hôpital Pierre Wertheimer, Lyon, France
| | - Alexandre Vasiljevic
- Lyon University, Université Claude Bernard Lyon 1, Lyon, France
- Department of Pathology, Groupement Hospitalier, Lyon, France
- INSERM U1052, CNRS UMR5286, Cancer Research Center of Lyon, Lyon, France
- INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, Neuro-Oncology & Neuro–Inflammation Team, Lyon, France
| | - Hélène Lasolle
- Lyon University, Université Claude Bernard Lyon 1, Lyon, France
- INSERM U1052, CNRS UMR5286, Cancer Research Center of Lyon, Lyon, France
- Endocrinology Department, Reference Center for Rare Pituitary Diseases HYPO, “Groupement Hospitalier Est” Hospices Civils de Lyon, “Claude Bernard” Lyon 1 University, Hôpital Louis Pradel, Lyon, France
| | - Francois Ducray
- Lyon University, Université Claude Bernard Lyon 1, Lyon, France
- Cancerology Research Center of Lyon, INSERM U1052, CNRS UMR 5286, Cancer Cell Plasticity Department, Transcriptome Diversity in Stem Cells Laboratory, Lyon, France
- Service of Neuro-Oncology, Hospices Civils de Lyon, Groupement Hospitalier Est, Neurology Hospital, Lyon, France
| | - Gerald Raverot
- Lyon University, Université Claude Bernard Lyon 1, Lyon, France
- INSERM U1052, CNRS UMR5286, Cancer Research Center of Lyon, Lyon, France
- Endocrinology Department, Reference Center for Rare Pituitary Diseases HYPO, “Groupement Hospitalier Est” Hospices Civils de Lyon, “Claude Bernard” Lyon 1 University, Hôpital Louis Pradel, Lyon, France
| | - Emmanuel Jouanneau
- Pituitary and Skull Base Neurosurgical Department, Reference Center for Rare Pituitary Diseases HYPO, “Groupement Hospitalier Est” Hospices Civils de Lyon, “Claude Bernard” Lyon 1 University, Hôpital Pierre Wertheimer, Lyon, France
- Lyon University, Université Claude Bernard Lyon 1, Lyon, France
- CREATIS Laboratory CNRS UMR5220, Inserm U1206, INSA-Lyon, University of Lyon 1, Lyon, France
- INSERM U1052, CNRS UMR5286, Cancer Research Center of Lyon, Lyon, France
| |
Collapse
|
17
|
Henderson F, Schwartz TH. Update on management of craniopharyngiomas. J Neurooncol 2021; 156:97-108. [PMID: 34807341 DOI: 10.1007/s11060-021-03906-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/17/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE/INTRODUCTION Craniopharyngiomas are locally-aggressive tumors arising along the hypothalamic-pituitary axis. Treatment is nuanced as a result of their proximity and adherence to vital neurovascular structures and responsiveness to surgery, radiation and, in some cases, chemotherapy. METHODS We reviewed the literature discussing the current state of knowledge regarding craniopharyngioma biology and therapy. RESULTS Recent advances in endoscopic endonasal surgery (EEA) have made surgery a safer and more effective option. While cure may be achieved with gross total resection (GTR), when felt to be too risky, a subtotal resection followed by radiation is often a more prudent strategy, particularly in children with hypothalamic invasion. Data on long-term outcome are mostly derived from older studies in which a craniotomy, rather than EEA, was performed. Long-term EEA outcome studies are lacking. Enhanced knowledge of the biological basis of papillary CPs has led to novel medical treatments for BRAFv600E variants that appear to be effective. CONCLUSION Endoscopic technology has improved surgical results for craniopharyngiomas and expanded the indications for the transsphenoidal approach. The goal of CP surgery goal is maximal safe resection to achieve cure, but subtotal resection and radiation may be equally effective. Early diagnosis of specific variants will facilitate enrollment in promising medical trials.
Collapse
Affiliation(s)
- Fraser Henderson
- Department of Neurological Surgery, Weill Cornell Medicine, NewYork-Presbyterian Hospital, 525 East 68th St, Box #99, New York, NY, 10065, USA
| | - Theodore H Schwartz
- Department of Neurological Surgery, Weill Cornell Medicine, NewYork-Presbyterian Hospital, 525 East 68th St, Box #99, New York, NY, 10065, USA.
| |
Collapse
|
18
|
Hamblin R, Tsermoulas G, Karavitaki N. Craniopharyngiomas. Presse Med 2021; 50:104078. [PMID: 34688870 DOI: 10.1016/j.lpm.2021.104078] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/03/2021] [Accepted: 10/12/2021] [Indexed: 11/29/2022] Open
Abstract
Craniopharyngiomas are rare epithelial tumours situated primarily in the sellar/parasellar region, occurring along the path of the craniopharyngeal duct. Whilst classed as histologically benign tumours, their unpredictable growth pattern and proximity to vital structures including the optic chiasm, hypothalamus, and pituitary gland renders them a considerable threat, with significant associated morbidity and increase in mortality. Occurring both in child and adulthood, their clinical manifestations are broad, commonly with symptoms/signs secondary to hypothalamic-pituitary dysfunction, raised intracranial pressure and visual compromise. They have two distinct histological subtypes (adamantinomatous and papillary), with unique patterns of age distribution, and genetic and molecular make-up. With increasing understanding of their genetic pathogenesis including BRAF V600E mutations in the papillary subtype, and β-catenin mutations in the adamantinomatous, further research provides hope for the discovery of targeted medical therapy that can exploit molecular changes occurring as a result of such alterations. Until then, primary treatment consists of surgery with or without radiotherapy, with intracystic aspiration, chemotherapy or irradiation being alternative options in selected patients. Long term management by an experienced multidisciplinary team is essential, given the breadth of complications, including hypothalamic morbidity, visual compromise, cognitive and neuropsychological sequelae and impairment to quality of life.
Collapse
Affiliation(s)
- Ross Hamblin
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK; Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Georgios Tsermoulas
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK; Department of Neurosurgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Niki Karavitaki
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK; Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| |
Collapse
|
19
|
Cheetham T, Wood C. Quality of life in craniopharyngioma: sorting out cause from association. Dev Med Child Neurol 2021; 63:895. [PMID: 34018183 DOI: 10.1111/dmcn.14902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Tim Cheetham
- Newcastle University c/o Department of Paediatric Endocrinology, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
| | - Claire Wood
- Newcastle University c/o Department of Paediatric Endocrinology, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
| |
Collapse
|
20
|
Fukuhara N, Iwata T, Inoshita N, Yoshimoto K, Kitagawa M, Fukuhara H, Tatsushima K, Yamaguchi-Okada M, Takeshita A, Ito J, Takeuchi Y, Yamada S, Nishioka H. Immunohistochemistry or Molecular Analysis: Which Method Is Better for Subtyping Craniopharyngioma? Endocr Pathol 2021; 32:262-268. [PMID: 32965631 DOI: 10.1007/s12022-020-09644-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2020] [Indexed: 10/23/2022]
Abstract
Craniopharyngioma (CP) is mainly classified into two pathological subtypes: adamantinomatous (ACP) and papillary (PCP). CTNNB1 (β-catenin) mutations are detected in ACPs, and the BRAF V600E mutation is detected in PCPs. However, genetic analysis is not always possible in general medical practice. In this study, we investigated whether immunohistochemistry could replace genetic analysis as an aid in subtype diagnosis. Here, 38 CP patients who had undergone their first tumor resection were included. Among the 38 cases, 22 were morphologically diagnosed as ACP, 10 cases were diagnosed as PCP, and six cases were diagnosed as undetermined CP that were morphologically difficult to classify as either ACP or PCP. Results of immunohistochemistry and genetic analysis and clinical features were compared. Based on the immunohistochemistry, 26 (22 ACPs and four undetermined CPs) showed nuclear β-catenin expression, 11 (nine PCPs and two undetermined CPs) exhibited positive BRAF V600E immunostaining, and one PCP showed membranous β-catenin expression and negative BRAF V600E immunostaining. Among the 26 nuclear β-catenin expression cases, 11 had CTNNB1 mutations; however, 15 cases had mutations of neither CTNNB1 nor BRAF V600E. All 11 BRAF V600E immunopositive cases had BRAF V600E mutations. When comparing clinical features, pediatric patients and those with tumor calcification and less solid components on MRI more commonly had nuclear β-catenin expression tumors than BRAF V600E immunopositive tumors, reflecting the differences in clinical features between ACP and PCP. Accordingly, immunohistochemistry can replace genetic analysis as an aid to determine the subtype diagnosis of CP in general medical practice.
Collapse
Affiliation(s)
- Noriaki Fukuhara
- Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital, Tokyo, Japan
- Department of Comprehensive Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Takeo Iwata
- Department of Functional Morphology, Niigata University of Pharmacy and Applied life Sciences, Niigata, Japan
- Department of Medical Pharmacology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Naoko Inoshita
- Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital, Tokyo, Japan.
- Department of Comprehensive Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan.
- Department of Pathology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan.
| | - Katsuhiko Yoshimoto
- Department of Medical Pharmacology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Masanobu Kitagawa
- Department of Comprehensive Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hirokazu Fukuhara
- Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital, Tokyo, Japan
| | - Keita Tatsushima
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan
| | | | - Akira Takeshita
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan
| | - Junko Ito
- Department of Pediatrics, Toranomon Hospital, Tokyo, Japan
| | - Yasuhiro Takeuchi
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan
| | - Shozo Yamada
- Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan
- Department of Neurosurgery, Tokyo Neurological Center, Tokyo, Japan
| | - Hiroshi Nishioka
- Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital, Tokyo, Japan
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| |
Collapse
|
21
|
Asha MJ, Oswari S, Takami H, Velasquez C, Almeida JP, Gentili F. Craniopharyngiomas: Challenges and Controversies. World Neurosurg 2021; 142:593-600. [PMID: 32987615 DOI: 10.1016/j.wneu.2020.05.172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 04/05/2020] [Indexed: 12/24/2022]
Abstract
Despite its benign histopathology, the treatment of craniopharyngioma remains one of the most formidable challenges faced by skull base surgeons. The technical challenges of tackling these complex central skull base lesions are paralleled by clinical challenges related to their unique tumor biology and the often-complex decision making required. In this article, we critically appraise the most recent literature to explore the challenges and controversies surrounding the management of these lesions. The role of curative resections and the shift in the surgical paradigm toward the multidisciplinary goal-directed management approach are discussed.
Collapse
Affiliation(s)
- Mohammed J Asha
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
| | - Selfy Oswari
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Hirokazu Takami
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Carlos Velasquez
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Joao Paulo Almeida
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Fred Gentili
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
22
|
Park DJ, Mishra A, Golub D, Li JY, Black KS, Schulder M. Papillary craniopharyngioma in a patient following resection of nonfunctioning pituitary adenoma: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE2063. [PMID: 35854932 PMCID: PMC9241323 DOI: 10.3171/case2063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/15/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although craniopharyngioma and pituitary adenoma are common tumors of the sellar or suprasellar region, the development of papillary craniopharyngioma in the same sellar region after resection of a nonfunctioning pituitary adenoma has not been reported. OBSERVATIONS Here the authors report the first case of craniopharyngioma that developed long after resection of a pituitary adenoma. A 66-year-old male patient underwent endoscopic transsphenoidal resection for a large sellar mass, which histopathologically confirmed the diagnosis of a pituitary adenoma. He had an excellent recovery after surgery. For several years, he had no clinical or imaging evidence of tumor recurrence and then was lost to follow-up. Seven years after the initial surgery, the patient returned with a one-month history of visual field defects, and imaging confirmed a heterogeneous, cystic suprasellar mass. Endoscopic transsphenoidal resection of the tumor was performed, and histological examination showed it to be a papillary craniopharyngioma. LESSONS Neurosurgeons should be aware that after pituitary adenoma resection, a recurrent mass could be a craniopharyngioma, with implications for very different management recommendations.
Collapse
Affiliation(s)
- David J. Park
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; and
- Departments of Neurosurgery,
| | - Akash Mishra
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; and
- Departments of Neurosurgery,
| | - Danielle Golub
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; and
- Departments of Neurosurgery,
| | - Jian Y. Li
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; and
- Radiology, and
| | - Karen S. Black
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; and
- Pathology and Laboratory Medicine, North Shore University Hospital, Manhasset, New York
| | - Michael Schulder
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; and
- Departments of Neurosurgery,
| |
Collapse
|
23
|
Subtype-dependent difference of glucose transporter 1 and hexokinase II expression in craniopharyngioma: an immunohistochemical study. Sci Rep 2021; 11:126. [PMID: 33420213 PMCID: PMC7794328 DOI: 10.1038/s41598-020-80259-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/17/2020] [Indexed: 11/08/2022] Open
Abstract
Papillary craniopharyngiomas are characterized by the BRAF V600E mutation. Enhancement of glucose metabolism may be involved in the downstream of the BRAF V600E mutation in many types of tumors. Glucose metabolism was investigated in craniopharyngioma using immunohistochemical analysis. The study included 29 cases of craniopharyngioma (18 adamantinomatous type [ACP], 11 papillary type [PCP]). Immunohistochemical analysis was performed with anti-glucose transporter-1 (GLUT-1), anti-hexokinase-II (HK-II), anti-BRAF V600E, and anti-beta-catenin antibodies. Expressions of GLUT-1 and HK-II were evaluated using a semiquantitative 4-tiered scale as 0, 1+, 2+, 3+, and divided into negative (0 or 1+) or positive (2+ or 3+) group. GLUT-1 expression level was significantly higher in PCPs than ACPs (0, 1+, 2+, 3+ = 2, 12, 4, 0 cases in ACP, respectively, 0, 1+, 2+, 3+ = 0, 2, 5, 4 in PCP, p = 0.001), and most PCPs were classified into positive group (positive rate, 22.2% [4/18] in ACP, 81.8% [9/11] in PCP; p = 0.003). HK-II expression was also conspicuous in PCPs (0, 1+, 2+, 3+ = 7, 9, 2, 0 cases in ACP, 0, 3, 3, 5 in PCP; p = 0.001), and most of them divided into positive group (positive rate, 11.1% [2/18] in ACP, 72.7% [8/11] in PCP; p = 0.001). Expression patterns of BRAF V600E and beta-catenin reflected the clinicopathological subtypes. Both GLUT-1 and HK-II expressions were prominent in PCP. Glucose metabolism might be more enhanced in PCP than ACP. PCP may use the glucose metabolic system downstream of the BRAF V600E mutant protein.
Collapse
|
24
|
Martinez-Barbera JP, Andoniadou CL. Biological Behaviour of Craniopharyngiomas. Neuroendocrinology 2020; 110:797-804. [PMID: 32126562 DOI: 10.1159/000506904] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 03/02/2020] [Indexed: 11/19/2022]
Abstract
Jakob Erdheim (1874-1937) first described craniopharyn-giomas (CPs) as "hypophyseal duct tumours" and postulated the existence of two tumour types based on their histological features: (1) an aggressive type showing similarities to adamantinomas (tumours of the jaw) and (2) a more benign form characterised by the presence of papillary structures. More than a century later, these initial observations have been confirmed; based on their distinct genetic, epigenetic, and histological features, the WHO classifies CPs into two types: adamantinomatous CPs (ACPs) and papillary CPs (PCPs). Considerable knowledge has been generated on the biology of CPs in the last 20 years. Mutations in CTNNB1 (encoding β-catenin) are prevalent in ACP, whilst PCPs frequently harbour mutations in BRAF (p.BRAF-V600E). The consequence of these mutations is the activation of either the WNT/β-catenin (ACP) or the MAPK/ERK (PCP) pathway. Murine models support a critical role for these mutations in tumour formation and have provided important insights into tumour pathogenesis, mostly in ACP. A critical role for cellular senescence has been uncovered in murine models of ACP with relevance to human tumours. Several gene profiling studies of human and murine ACP tumours have identified potential targetable pathways, and novel therapeutic agents are being used in clinical and pre-clinical research, in some cases with excellent results. In this review, we will present the accumulated knowledge on the biological features of these tumours and summarise how these advances are being translated into potential novel treatments.
Collapse
Affiliation(s)
- Juan Pedro Martinez-Barbera
- Developmental Biology and Cancer, Birth Defect Research Centre, GOS Institute of Child Health, University College London, London, United Kingdom,
| | - Cynthia Lilian Andoniadou
- Centre for Craniofacial and Regenerative Biology, Faculty of Dental, Oral, and Craniofacial Sciences, King's College London, London, United Kingdom
| |
Collapse
|
25
|
Manojlovic-Gacic E, Rostami E, Karavitaki N, Casar-Borota O. Histopathology of Parasellar Neoplasms. Neuroendocrinology 2020; 110:740-752. [PMID: 32155632 PMCID: PMC7490502 DOI: 10.1159/000507084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 03/09/2020] [Indexed: 01/28/2023]
Abstract
The anatomical and histological complexity of the parasellar region as well as the presence of embryonic remnants determine the huge diversity of parasellar neoplasms. Some of them are only located in the parasellar region, whereas others can occur elsewhere, within or outside the central nervous system. Their spectrum ranges from histologically benign and low-grade malignant to high-grade malignant tumours. Although rare, metastases can pose differential diagnostic dilemmas. The severity of the clinical picture, the challenges of surgery and the risk of adverse sequelae related to surgery or radiotherapy make parasellar tumours interesting entities for the clinicians irrespective of their histological malignancy grade. Due to the different cell origins of parasellar tumours, the World Health Organization classification system does not categorise them as a distinct group. Detailed criteria for classification and malignancy grading are presented in the classification systems covering central nervous system tumours, haematological malignancies and tumours of the soft tissue and bone. In the last few years, molecular genetic features have been integrated into the diagnosis of several types of the parasellar tumours enhancing diagnostic accuracy and providing information of the value for targeting therapies. In this review, we will present histopathological and molecular genetic features, updated classification criteria and recent advances in the diagnostics and rationale for novel pharmacological therapies of selected types of parasellar neoplasms.
Collapse
Affiliation(s)
| | - Elham Rostami
- Section of Neurosurgery, Department of Neuroscience, Uppsala University, Uppsala, Sweden
- Department of Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Niki Karavitaki
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Olivera Casar-Borota
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden,
- Department of Clinical Pathology, Uppsala University Hospital, Uppsala, Sweden,
| |
Collapse
|