Craniopharyngioma medical therapy: Difference between revisions

Jump to navigation Jump to search
Line 9: Line 9:
For treatment purposes, patients are grouped as having ''newly diagnosed'' or ''recurrent disease''.<ref>Rx of Craniopharyngioma. Cancer gov. http://www.cancer.gov/types/brain/hp/child-cranio-treatment-pdq#link/_40_toc</ref>
For treatment purposes, patients are grouped as having ''newly diagnosed'' or ''recurrent disease''.<ref>Rx of Craniopharyngioma. Cancer gov. http://www.cancer.gov/types/brain/hp/child-cranio-treatment-pdq#link/_40_toc</ref>


====Newly diagnosed craniopharyngioma====
===Newly diagnosed craniopharyngioma===
There is no consensus on the optimal treatment for newly diagnosed craniopharyngioma, in part because of the lack of prospective randomized trials that compare the different treatment options. Treatment is individualized on the basis of factors that include the following:
There is no consensus on the optimal treatment for newly diagnosed craniopharyngioma, in part because of the lack of prospective randomized trials that compare the different treatment options. Treatment is individualized on the basis of factors that include the following:
#Tumor size
#Tumor size
Line 18: Line 18:
Treatment options for newly diagnosed craniopharyngioma include the following:
Treatment options for newly diagnosed craniopharyngioma include the following:
*Radical surgery with or without radiation therapy.
*Radical surgery with or without radiation therapy.
**It is possible to remove all visible tumor and achieve long-term disease control because these tumors are histologically benign
**A 5-year progression-free survival (PFS) rate of about 65% has been reported
**Radical surgical approaches include the following:
***'''Transsphenoidal approach''': A transsphenoidal approach may be possible for some small tumors located entirely within the sella. The development of expanded ''endonasal techniques with endoscopic visualization'' have allowed this approach to be increasingly used, even for sizeable tumors.
***'''Craniotomy''': When an endonasal approach is not possible, a craniotomy is required. The surgeon often has a limited view of the hypothalamic and sellar regions, and portions of the mass may remain after surgery, accounting for some recurrences. Almost all craniopharyngiomas have an attachment to the pituitary stalk, and of the patients who undergo radical surgery, virtually all will require life-long pituitary hormone replacement with multiple medications.
*Subtotal resection with radiation therapy.
*Subtotal resection with radiation therapy.
*Primary cyst drainage with or without radiation therapy.
*Primary cyst drainage with or without radiation therapy.

Revision as of 16:43, 23 August 2015

Craniopharyngioma Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Craniopharyngioma from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Treatment

Medical Therapy

Surgery

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Craniopharyngioma medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Craniopharyngioma medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Craniopharyngioma medical therapy

CDC on Craniopharyngioma medical therapy

Craniopharyngioma medical therapy in the news

Blogs on Craniopharyngioma medical therapy

Directions to Hospitals Treating Craniopharyngioma

Risk calculators and risk factors for Craniopharyngioma medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Patients with craniopharyngioma have many treatment options. The selection depends on the size, location of the tumor. The options are surgery, radiation therapy, chemotherapy, or a combination of these methods.

Medical Therapy

For treatment purposes, patients are grouped as having newly diagnosed or recurrent disease.[1]

Newly diagnosed craniopharyngioma

There is no consensus on the optimal treatment for newly diagnosed craniopharyngioma, in part because of the lack of prospective randomized trials that compare the different treatment options. Treatment is individualized on the basis of factors that include the following:

  1. Tumor size
  2. Tumor location
  3. Extension of the tumor.
  4. Potential short-term and long-term toxicity.

Treatment options for newly diagnosed craniopharyngioma include the following:

  • Radical surgery with or without radiation therapy.
    • It is possible to remove all visible tumor and achieve long-term disease control because these tumors are histologically benign
    • A 5-year progression-free survival (PFS) rate of about 65% has been reported
    • Radical surgical approaches include the following:
      • Transsphenoidal approach: A transsphenoidal approach may be possible for some small tumors located entirely within the sella. The development of expanded endonasal techniques with endoscopic visualization have allowed this approach to be increasingly used, even for sizeable tumors.
      • Craniotomy: When an endonasal approach is not possible, a craniotomy is required. The surgeon often has a limited view of the hypothalamic and sellar regions, and portions of the mass may remain after surgery, accounting for some recurrences. Almost all craniopharyngiomas have an attachment to the pituitary stalk, and of the patients who undergo radical surgery, virtually all will require life-long pituitary hormone replacement with multiple medications.
  • Subtotal resection with radiation therapy.
  • Primary cyst drainage with or without radiation therapy.

Recurrent craniopharyngioma

  • Surgery
  • Radiation therapy, including radiosurgery
  • Intracavitary instillation of radioactive P-32, bleomycin, or interferon-alpha, for those with cystic recurrences
  • Systemic interferon

References


Template:WikiDoc Sources