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Long‐term clinical outcomes following treatment of childhood craniopharyngioma
Author(s) -
Winkfield Karen M.,
Tsai Henry K.,
Yao Xiaopan,
Larson Elysia,
Neuberg Donna,
Pomeroy Scott L.,
Ullrich Nicole J.,
Cohen Laurie E.,
Kieran Mark W.,
Scott R. Michael,
Goumnerova Liliana C.,
Marcus Karen J.
Publication year - 2010
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.22884
Subject(s) - medicine , craniopharyngioma , surgery , radiation therapy , proportional hazards model , pediatrics
Abstract Purpose To review our institution's experience with treatment of craniopharyngioma in children, and to report long‐term treatment outcomes stratified by treatment era to assess whether modern treatment techniques result in improvements in local control and survival. Materials and Methods We retrospectively reviewed the records of 100 children who underwent surgery for craniopharygioma at Children's Hospital Boston (CHB) from August 1976 to March 2003. Of these, 79 children (median age 8.5 years) had initial treatment at CHB and sufficient follow‐up data to be included in this analysis. We report their treatment course, recurrence rates, and treatment‐related morbidity. We compared the results in two different treatment eras based on changes in surgical approach at CHB. Results Thirty‐six patients underwent initial treatment with surgery alone; 63% treated prior to 1988 recurred and 36% treated after 1988 recurred. Recurrence rates following combined modality therapy (CMT) with limited surgery followed by radiation were 21 and 5% in the pre‐ and post‐1988 eras, respectively. Accounting for treatment era, patients treated with surgery alone were 7.7 times as likely to recur as those treated with CMT (95%CI: 2.0, 28.7). In the Cox regression model, there was no significant difference in local control or overall survival based on treatment era; initial treatment remained the only statistically significant variable ( P = 0.02). Conclusions Advancements in treatment techniques have improved local control in children diagnosed with craniopharyngioma. The excellent survival rates necessitate long‐term patient follow‐up to identify and manage any treatment‐related effects, including second tumors, vascular abnormalities, and endocrinopathies. Pediatr Blood Cancer 2011;56:1120–1126. © 2010 Wiley‐Liss, Inc.