Pre- and Posttherapy Risk Factors for Vasculopathy in Pediatric Patients With Craniopharyngioma Treated With Surgery and Proton Radiation Therapy

Lucas, John T.; Faught, Austin M.; Hsu, Chih Yang; Wilson, Lydia; Guo, Yian; Li, Yimei; Khan, Raja B.; Becksfort, Jared; Levine, David A.; Ismael, Yousef; Darrow, Kaleb; Moskvin, V.; Pirlepesov, F.; Klimo, Paul; Elijovich, Lucas; Indelicato, Daniel J.; Boop, Fredrick A.; Merchant, Thomas E.

doi:10.1016/j.ijrobp.2021.12.172

Cited by 6 publications

(8 citation statements)

References 41 publications

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“…Other neurovascular complications included hematoma (two cases post-surgery), radiation-induced large vessel cerebral vasculopathy such as arterial stenosis and occlusion (two cases post-radiotherapy), pseudoaneurysm (one case after subtotal resection and radiotherapy), cerebroartherosclerosis (one case post-radiotherapy), and intracranial venous thrombosis (one case post-surgery for recurrence) ( Table 3 ). Lucas et al’s study reported 9 post-surgery stenosis cases and 22 stenosis cases post-PBT for childhood CP—3 patients presented with dilated perivascular space years after PBT [ 44 ]. Only hematoma was reported in both childhood- and adult-onset CP patients.…”

Section: Resultsmentioning

confidence: 99%

“…While FDCA, stroke/TIA, and aneurysms occur shortly after surgery, the radiation-related vasculopathies manifest as a late sequela. Lucas et al reported no added radiotherapy-related risk of vascular morbidity in their patients [ 44 ]. However, further studies using screening for radiation-related vasculopathies are needed to evaluate the diagnostic value of routine MRA in aftercare.…”

Section: Discussionmentioning

confidence: 99%

“…The following supporting information can be downloaded at , Table S1: Data extraction table [ 8 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , …”

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Vascular Morbidity and Mortality in Craniopharyngioma Patients—A Scoping Review

Beckhaus,

Friedrich,

Müller

2024

Cancers

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Craniopharyngioma (CP) treatment, including surgery and radiotherapy, can have short- and long-term vascular side effects. Hypothalamic damage is related to morbid obesity and may increase the lifelong risk of experiencing vascular events in CP patients. This review summarized the available evidence regarding vascular complications in adamantinomatous or papillary CP patients, whatever their age at diagnosis. Three databases (Medline, CINAHL, Web of Science) were searched (06/2023) to retrieve eligible articles. The search was limited to peer-reviewed articles. Titles, abstracts, and full texts were screened by two independent reviewers, and data were extracted using a self-developed grid. Seventy-two studies were included in this review; the majority were case reports. Reported vascular sequela that occurred due to surgery were fusiform dilation of the carotid artery, stroke, vasospasm, hemorrhage, and aneurysm. Related conditions that emerged due to radiotherapy included Moyamoya syndrome and cavernoma. Cardiovascular morbidity and mortality often lead to hypothalamic obesity and metabolic syndrome in CP patients. Vascular damage is a rare complication of CP treatment. Surgical strategies should protect the surrounding hypothalamic and vascular structures. Patients receiving radiotherapy, particularly at a young age, should undergo magnetic resonance angiography monitoring to identify possible neurovascular sequela during post-treatment care.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Vascular Morbidity and Mortality in Craniopharyngioma Patients—A Scoping Review

Beckhaus,

Friedrich,

Müller

2024

Cancers

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“…While radiotherapy was used frequently for LGGs and benign histologies, such as craniopharyngioma and meningiomas many decades ago, radiation is more frequently omitted now with better surgeries and systemic agent options [30,[110][111][112][113][114][115][116][117][118]. For LGGs, radiation is effective in improving symptoms, such as vision deficits, and can provide excellent local control [110,111,[119][120][121].…”

Section: Low-grade Glioma and Benign Histologiesmentioning

confidence: 99%

Radiotherapy for Primary Pediatric Central Nervous System Malignancies: Current Treatment Paradigms and Future Directions

Liu,

Haas-Kogan,

Elhalawani

2023

Pediatr Neurosurg

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Background: Central nervous system tumors are the most common solid tumors in childhood. Treatment paradigms for pediatric central nervous system malignancies depend on elements including tumor histology, age of patient, and stage of disease. Radiotherapy is an important modality of treatment for many pediatric central nervous system malignancies. Summary: While radiation contributes to excellent overall survival rates for many patients, radiation also carries significant risks of long-term side effects including neurocognitive decline, hearing loss, growth impairment, neuroendocrine dysfunction, strokes, and secondary malignancies. In recent decades, clinical trials have demonstrated that with better imaging and staging along with more sophisticated radiation planning and treatment set-up verification, smaller treatment volumes can be utilized without decrement in survival. Furthermore, the development of intensity-modulated radiotherapy and proton-beam radiotherapy has greatly improved conformality of radiation. Key Messages: Recent changes in radiation treatment paradigms have decreased risks of short- and long-term toxicity for common histologies and in different age groups. Future studies will continue to develop novel radiation regimens to improve outcomes in aggressive central nervous system tumors, integrate molecular subtypes to tailor radiation treatment, and decrease radiation-associated toxicity for long-term survivors.

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“…However, studies have shown that aggressive gross total resection (GTR) carries a high risk of damage to adjacent brain structures, resulting in significant and chronic complications, most commonly affecting vision and neuroendocrine function [3] , [4] , [5] . Radiotherapy, as an adjuvant or alternative to surgery, is associated with similar risk of pituitary damage, as well as added complications such as vasculopathy, radiation-induced malignancy, and heightened risk of recurrence [6] , [7] , [8] . Given these risks, there have been efforts to transition to more targeted treatment approaches that decrease the possibility of damage and associated complications.…”

Section: Introductionmentioning

confidence: 99%