Proton Therapy for Craniopharyngioma: Early Clinical Outcomes

Indelicato, Daniel J.; Rotondo, Ronny L.; Flampouri, Stella; Kowalchik, Kristin; Sandler, Eric; Aldana, Philipp R.; Merchant, Thomas E.; Mendenhall, Nancy P.; Marcus, Robert B.

doi:10.1016/j.ijrobp.2012.07.1692

Cited by 11 publications

(6 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…IMRT is an advanced mode of high-precision radiotherapy that delivers precise radiation doses to conform more precisely to the three-dimensional shape of a tumour by modulating the intensity of the radiation beam in multiple small volumes, thus limiting radiation scatter to surrounding unaffected structures by up to 45% ( 67 ). Proton beam therapy is now used preferentially in the treatment of craniopharyngiomas due to the ability to limit the distribution and intensity of the radiation dose, in-turn reducing the risk of complications and secondary cancer, whilst improving target conformity ( 68 , 69 ), with some case series reporting a 100% 5-year control rate ( 70 – 72 ). Extension beyond tumour margins is now limited to 5mm to prevent the extension of radiation to normal surrounding structures ( 73 ).…”

Section: Current Approaches To Managing Hypothalamic Obesitymentioning

confidence: 99%

Treatment of Acquired Hypothalamic Obesity: Now and the Future

Dimitri

2022

Front. Endocrinol.

View full text Add to dashboard Cite

The hypothalamus is the centre of neuroendocrine regulation of energy homeostasis and appetite. Maldevelopment of, or damage to, the key hypothalamic nuclei disrupts the coordinated balance between energy intake and expenditure leading, to rapid and excessive weight gain. Hypothalamic obesity is compounded by a disruption of the hypothalamic-pituitary axis, sleep disruption, visual compromise, and neurological and vascular sequalae. Amongst suprasellar tumors, craniopharyngioma is the most common cause of acquired hypothalamic obesity, either directly or following surgical or radiotherapeutic intervention. At present, therapy is limited to strategies to manage obesity but with a modest and variable impact. Current approaches include optimizing pituitary hormone replacement, calorie restriction, increased energy expenditure through physical activity, behavioral interventions, pharmacotherapy and bariatric surgery. Current pharmacotherapeutic approaches include stimulants that increase energy consumption, anti-diabetic agents, hypothalamic–pituitary substitution therapy, octreotide, and methionine aminopeptidase 2 (MetAP2) inhibitors. Some pharmacological studies of hypothalamic obesity report weight loss or stabilization but reported intervention periods are short, and others report no effect. The impact of bariatric surgery on weight loss in hypothalamic obesity again is variable. Novel or combined approaches to manage hypothalamic obesity are thus required to achieve credible and sustained weight loss. Identifying etiological factors contributing hypothalamic obesity may lead to multi-faceted interventions targeting hyperphagia, insulin resistance, decreased energy expenditure, sleep disturbance, hypopituitarism and psychosocial morbidity. Placebo-controlled trials using current single, or combination therapies are required to determine the impact of therapeutic agents. A well-defined approach to defining the location of hypothalamic damage may support the use of future targeted therapies. Intranasal oxytocin is currently being investigated as an anorexogenic agent. Novel agents including those targeting pro-opimelanocortin-C and AgRP/NPY expressing neurons and the MC4 receptor may result in better outcomes. This article discusses the current challenges in the management of hypothalamic obesity in children and young people and future therapeutic approaches to increasing weight loss and quality of life in these patients.

show abstract

Section: Current Approaches To Managing Hypothalamic Obesitymentioning

confidence: 99%

Treatment of Acquired Hypothalamic Obesity: Now and the Future

Dimitri

2022

Front. Endocrinol.

View full text Add to dashboard Cite

show abstract

“…15 Another study on craniopharyngioma treated with proton therapy claimed 100% early tumor control and survival with minimal acute toxicities. 16 Independent of radiation modality, the optic chiasm and pituitary gland are included in the target volume and thus we do not expect significant differences between patients treated with proton and photon therapy in these domains. 17 However, because of the ability of proton therapy to largely spare the temporal lobes and hippocampi, it may prevent or attenuate intelligence quotient decline compared with craniopharyngioma patients treated with photon therapy.…”

Section: Discussionmentioning

confidence: 92%

Simultaneous Diagnosis of Craniopharyngioma in 2 Brothers

Liu¹,

Indelicato²,

Bradley³

et al. 2020

Journal of Pediatric Hematology/Oncology

View full text Add to dashboard Cite

Craniopharyngioma is a rare suprasellar tumor. Approximately one-third of cases occur in pediatric patients. Depending on the size and extent of the lesion, the main treatment options include complete surgical removal of the tumor or limited surgery followed by radiotherapy. Craniopharyngiomas are not thought to be hereditary. Herein the authors present a case report of 2 brothers, ages 9 and 10, diagnosed with craniopharyngioma within weeks of each other and managed with different approaches. One sibling underwent gross total resection followed by observation while the other underwent biopsy followed by postoperative proton therapy.

show abstract

“…Compared with photon therapy, proton therapy offers a better opportunity to preserve IQ scores in patients with craniopharyngioma 13 . In a review of 40 pediatric craniopharyngioma patients who received proton radiotherapy, the 5-year local control and overall survival rates were 100% 14 . Table 1 reviews the published outcomes on patients with craniopharyngioma treated with proton therapy 14 – 22 .…”

Section: Proton Therapymentioning

confidence: 99%

“…In a review of 40 pediatric craniopharyngioma patients who received proton radiotherapy, the 5-year local control and overall survival rates were 100% 14 . Table 1 reviews the published outcomes on patients with craniopharyngioma treated with proton therapy 14 – 22 . A comparison of photon stereotactic radiotherapy and 3DCPT plans is shown in Figure 1 .…”

Section: Proton Therapymentioning

confidence: 99%

Advances in the management of craniopharyngioma

O’steen

Indelicato

2018

F1000Res

View full text Add to dashboard Cite

Craniopharyngioma is a curable benign tumor, but owing to its intimate relationship to critical structures in the central brain—such as the optic apparatus, pituitary, hypothalamus, intracranial vasculature, brain stem, and temporal lobes—its management introduces the risk of long-term treatment morbidity. Today, the most common treatment approach is conservative subtotal resection followed by radiotherapy, and the goal is to limit long-term toxicity. Many recent advances in the treatment of craniopharyngioma are attributable to improved surgical techniques and radiotherapy technologies.

show abstract

Proton Therapy for Craniopharyngioma: Early Clinical Outcomes

Cited by 11 publications

References 0 publications

Treatment of Acquired Hypothalamic Obesity: Now and the Future

Treatment of Acquired Hypothalamic Obesity: Now and the Future

Simultaneous Diagnosis of Craniopharyngioma in 2 Brothers

Advances in the management of craniopharyngioma

Contact Info

Product

Resources

About