Vascular abnormalities in pediatric craniopharyngioma patients treated with radiation therapy

Liu, Arthur K.; Bagrosky, Brian M.; Fenton, Laura Z.; Gaspar, Laurie E.; Handler, Michael H.; McNatt, Sean A.; Foreman, Nicholas K.

doi:10.1002/pbc.21787

Cited by 54 publications

(40 citation statements)

References 14 publications

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“…The authors suggested that these numbers might be higher with longer follow up. A single institution review found that 6 of 20 children had imaging evidence of vasculopathy, half of whom were symptomatic [27]. Of note, two of these children also had intracystic bleomycin, which also could have contributed to vascular risk.…”

Section: Risk Factorsmentioning

confidence: 99%

Review of cranial radiotherapy-induced vasculopathy

et al. 2015

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Cranial radiation can impact the cerebral vasculature in many ways, with a wide range of clinical manifestations. The incidence of these late effects including cerebrovascular accidents (CVAs), lacunar lesions, vascular occlusive disease including moyamoya syndrome, vascular malformations, and hemorrhage is not well known. This article reviews the preclinical findings regarding the pathophysiology of late radiation-induced vascular damage, and discusses the clinical incidence and risk factors for each type of vasculopathy. The pathophysiology is complex and dependent on the targeted blood vessels, and upregulation of pro-inflammatory and hypoxia-related genes. The risk factors for adult CVAs are similar to those for patients not exposed to cranial radiotherapy. For children, risks for late vascular complications include young age at radiotherapy, radiotherapy dose, NF1, tumor location, chemotherapy, and endocrine abnormalities. The incidence of late vascular complications of radiotherapy may be impacted by improved technology, therapeutic interventions, and appropriate follow up.

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Section: Risk Factorsmentioning

confidence: 99%

Review of cranial radiotherapy-induced vasculopathy

et al. 2015

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“…Liu et al 22 re ported on 6 patients in a series of 20 who developed a vasculopathy on neuroimaging after receiving radiation therapy for craniopharyngioma. Retrospective studies of radiation therapy directed at the sellar/suprasellar region have demonstrated an incidence as high as 21% for cere brovascular events.…”

Section: Cerebrovascular Diseasementioning

confidence: 99%

Radiation therapy for pediatric craniopharyngioma

Kiehna

Merchant

2010

FOC

118

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Object The treatment of craniopharyngioma is highly controversial. Continued advances in limited surgery and radiation therapy have maintained excellent local disease control while minimizing treatment-related sequelae. Further analyses of outcomes are necessary to characterize the long-term effects of radiation therapy. Methods An extensive literature review was performed for all studies including radiation therapy, with or without surgery, for pediatric craniopharyngioma. Results The authors identified 32 papers describing radiation therapy for treatment of pediatric craniopharyngioma, with disease control ranging from 44 to 100%. Modern studies report at least 90% disease control with 5-year follow-up. Fifteen studies reported outcomes, demonstrating that more than two-thirds of patients treated with surgery and radiation therapy have favorable outcomes, and this rate is more than 85% in the modern era. Conclusions Conservative surgery and radiation therapy results in long-term disease control in pediatric patients with craniopharyngioma that is comparable to results obtained with radical surgery alone. However, children with craniopharyngioma remain vulnerable to late treatment failures and side effects from radiation therapy, including endocrinopathies, vasculopathies, and secondary tumors, which may be detrimental to the quality of life. Long-term follow-up beyond 5–10 years is necessary to assess tumor control relative to functional outcomes.

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“…The risk of radiation injury depends on the dose (either total dose or per fraction), duration of treatment, and volume of normal brain irradiated (Regine et al, 1993;Chung et al, 1998;Chakrabarti et al, 2005;Kobayashi et al, 2005;Adler Jr. et al, 2006;Liu et al, 2009;Campbell et al, 2010;Hasegawa et al, 2010).…”

Section: Complications Of Radiation Therapymentioning

confidence: 99%