Hypothalamo‐pituitary‐adrenal axis integrity after cranial irradiation for childhood posterior fossa tumours

Spoudeas, Helen; Charmandari, Evangelia; Brook, C. G. D.

doi:10.1002/mpo.10267

Cited by 58 publications

(32 citation statements)

References 42 publications

(61 reference statements)

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“…Side effects of radiotherapy include dysfunction of the hy pothalamicpituitary axis and visual apparatus, benign and malignant radiationinduced CNS tumors, cognitive and at tentional deficits, and cerebrovasculopathy/moyamoya dis ease. [5][6][7]26,28,29,31,36,37,41,51,52,60,63,64,72,75,84,87,88,90,96,97,102,105,106 These effects are more pronounced in younger children 64,75 and are correlated with increasing target volume and total dos age. 28,36,72,86,87 These late effects must be recognized when comparing risk-benefit profiles of radical versus limited resection and radiotherapy.…”

Section: Side Effects Of Radiation Therapy and Impact On Reoperationmentioning

confidence: 99%

Efficacy and safety of radical resection of primary and recurrent craniopharyngiomas in 86 children

Elliott¹,

Hsieh²,

Hochm

et al. 2010

PED

157

148

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Object Optimal treatment of primary and recurrent craniopharyngiomas remains controversial. Radical resection and limited resection plus radiation therapy yield similar rates of disease control and overall survival. The data are much less clear for recurrent tumors. The authors report their experience with radical resection of both primary and recurrent craniopharyngiomas in children and compare the outcomes between the 2 groups. Methods A retrospective analysis was performed in 86 children younger than 21 years of age who underwent a total of 103 operations for craniopharyngioma between 1986 and 2008; these were performed by the senior author. The goal was resection with curative intent in all patients. Two patients were lost to follow-up and were excluded from analysis. The mean age at the time of surgery was 9.6 years, and the mean follow-up was 9.0 years. Results All 57 children with primary tumors underwent gross-total resection (GTR). A GTR was achieved in significantly fewer children with recurrent tumors (18 [62%] of 29). There were 3 perioperative deaths (3%). Tumor recurred after GTR in 14 (20%) of 71 patients. Overall survival and progression-free survival were significantly better in patients with primary tumors at time of presentation to the authors' institution. There were no significant differences in the neurological, endocrinological, visual, or functional outcomes between patients with primary and those with recurrent tumors. Factors negatively affecting overall survival and progression-free survival include subtotal resection (recurrent tumors only), tumor size ≥ 5 cm, or presence of hydrocephalus or a ventriculoperitoneal shunt. Prior radiation therapy and increasing tumor size were both risk factors for incomplete resection at reoperation. Conclusions In the hands of surgeons with experience with craniopharyngiomas, the authors believe that radical resection at presentation offers the best chance of disease control and potential cure with acceptable morbidity. While GTR does not preclude recurrence and is more difficult to achieve in recurrent tumors, especially large and previously irradiated tumors, radical resection is still possible in patients with recurrent craniopharyngiomas with morbidity similar to that of primary tumors.

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Section: Side Effects Of Radiation Therapy and Impact On Reoperationmentioning

confidence: 99%

Efficacy and safety of radical resection of primary and recurrent craniopharyngiomas in 86 children

Elliott¹,

Hsieh²,

Hochm

et al. 2010

PED

157

148

View full text Add to dashboard Cite

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“…Side effects of irradiation include dysfunction of the hypo thalamicpituitary axis, visual deterioration, radiationin duced CNS tumors, age-dependent cognitive deficits, pro gressive decline of IQ, and cerebrovasculopathy/moyamoya disease. [2][3][4]11,12,14,18,19,[24][25][26]28,36,37,43,45,46,54,56,63,[65][66][67][68][71][72][73]76,78,79,83 Critical risk factors for predicting increased morbidity from radiotherapy are younger age at irradiation, volume of the irradiated field, and total dosage. 18,24,46,54,65,66 Specifically, Neglia et al 56 noted these effects to be more pronounced in patients under 5 years of age.…”

Section: Discussionmentioning

confidence: 99%

Successful surgical treatment of craniopharyngioma in very young children

Elliott¹,

Wisoff

2009

PED

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Object Given the potential morbidity of cranial irradiation in young children, the risk-benefit analysis of limited surgery plus irradiation versus radical resection may favor the latter strategy. The purpose of this study was to assess the oncological, endocrinological, and functional outcomes of patients 5 years of age and younger who underwent radical resection of craniopharyngiomas. Methods Between 1991 and 2008, 19 children age ≤ 5 years were diagnosed with a craniopharyngioma and underwent radical resection by the senior author (J.H.W.). Data were retrospectively collected on these 19 patients (11 males, 8 females; mean age 3.2 years) to assess the efficacy and impact of surgical treatment. Results Eighteen (95%) of 19 patients underwent gross-total resection (GTR) confirmed by intraoperative inspection and postoperative imaging. There was no operative death and 18 of (95%) 19 patients were alive at a mean follow-up of 9.4 years (median 8.3 years). Six patients (31%) had a total of 7 tumor recurrences treated by repeat GTR in 5 patients and Gamma knife surgery in 1 patient. No patient required conventional, fractionated radiation therapy. Disease control was achieved surgically in 17 (89.5%) patients and with surgery and Gamma knife surgery in 1 patient, yielding an overall rate of disease control of 95% without the use of conventional radiotherapy. New-onset diabetes insipidus occurred in 50% of patients. Vision worsened in 1 patient, and there was no long-term neurological morbidity. Conclusions In this retrospective series, children aged ≤ 5 years with craniopharyngiomas can have excellent outcomes with minimal morbidity after radical resection by an experienced surgeon. Disease control in this population can be successfully achieved with GTR alone in the majority of cases, avoiding the detrimental effects of radiotherapy in this vulnerable population.

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“…A pesar de que la insuficiencia suprarrenal franca es un hallazgo raro, podemos encontrar en estos niños fatiga o cansancio fácil por una secreción suprarrenal insuficiente 23,38,39 . El diagnóstico se hace al objetivar una cifra baja de cortisol basal y una respuesta baja de cortisol a la hipoglucemia insulínica o tras la administración de factor liberador de corticotropina (CRF) 20 .…”

Section: Alteraciones Suprarrenalesunclassified

Evaluación de la pubertad y la función gonadal en pacientes pediátricos supervivientes de un cáncer infantil

Ibáñez

Martínez

Parareda

et al. 2007

Anales de Pediatría

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Tabla 2. Agentes citotóxicos más usados en Pediatría. Bloqueadores de la síntesis proteica L-Asparraginasa La radioterapia también tiene como finalidad la erradicación tumoral. Mediante la irradiación se generan moléculas con radicales libres altamente reactivas que alteran la estructura del ADN, llevando a una alteración en la proliferación celular. Se puede utilizar antes de la cirugía en un tumor inoperable, o con posterioridad a la misma para eliminar restos tumorales. También puede estar indicada en los síndromes dolorosos o compresivos producidos por el tumor o sus metástasis. Como las secuelas a largo plazo de la irradiación son dosis-dependientes, los niños que la precisan se tratan con la menor dosis eficaz. Sin embargo, la dosis de radioterapia, su fraccionamiento, la duración del tratamiento y el campo de irradiación dependerán del tipo de cáncer, la extensión de la enfermedad, la edad del paciente y su tolerancia al tratamiento. En general, los efectos adversos derivados de la radioterapia no aparecen de forma inmediata tras su administración, sino que se presentan después de un periodo de latencia más o menos Introducción 7 largo 7,10,11 . En la Tabla 3 se presenta la diferente radiosensibilidad de las células del organismo 12 . Grupo farmacológico Fármacos más usadosTabla 3. Tipos celulares según su radiosensibilidad. En algunos casos, el tratamiento del cáncer incluye la realización de un trasplante de médula ósea (TMO), ya sea autólogo o alogénico. El TMO se usa en el tratamiento de ciertos pacientes afectos de leucemia linfoblástica aguda (LLA), leucemia aguda no linfoblástica y aplasia medular grave 7,8,10,13 . Para ello, previamente se ha de preparar al receptor con regímenes de acondicionamiento que consisten en irradiación corporal total (ICT), o bien quimioterapia intensiva, por ejemplo, con busulfán y ciclofosfamida. Radiosensibilidad Tipos celulares Ejemplos AltaLos avances en la terapia antineoplásica han llevado a un significativo aumento de los índices de supervivencia en las últimas décadas, siendo actualmente el índice medio de curación del cáncer infantil del 70% 13,14 . Durante los últimos años se han producido mejorías en los tratamientos de quimioterapia y radioterapia, en los medios para Efectos secundarios del tratamiento antineoplásicoSe estima que casi la mitad de los supervivientes de un cáncer infantil pueden desarrollar problemas que afecten a su calidad de vida 10,11,13,15 . Aproximadamente dos tercios de los supervivientes tienen como mínimo un efecto tardío del tratamiento oncológico, y en un tercio de ellos las complicaciones que aparecen son graves 13 .Se han descrito secuelas de la terapia antineoplásica a nivel de todos los órganos y sistemas, dependiendo de la terapia específica a la que se ha expuesto el paciente (cirugía, quimioterapia única o combinada, radioterapia, trasplante de médula ósea) y su edad al inicio de la misma [10][11][12][13]15,17,18 . A pesar de que los niños toleran la toxicidad aguda del tratamiento mejor que los adultos, el niño puede ser má...

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Hypothalamo‐pituitary‐adrenal axis integrity after cranial irradiation for childhood posterior fossa tumours

Cited by 58 publications

References 42 publications

Efficacy and safety of radical resection of primary and recurrent craniopharyngiomas in 86 children

Efficacy and safety of radical resection of primary and recurrent craniopharyngiomas in 86 children

Successful surgical treatment of craniopharyngioma in very young children

Evaluación de la pubertad y la función gonadal en pacientes pediátricos supervivientes de un cáncer infantil

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