Chemotherapy with Adriamycin (doxorubicin) and CCNU (lomustine) in four children with recurrent craniopharyngioma.
BACKGROUND
The prognosis of craniopharyngioma in children after subtotal surgical removal, followed by irradiation of remaining tumour with 50 Gy, is better than usually reported. In our subjects we found a relapse rate of 5% in the last 20 years. The treatment of recurrences forms a special problem because the possibilities of adjuvant radiotherapy are restricted. We report on a chemotherapeutic treatment after multiple or very rapid recurrences of craniopharyngioma in four children.


METHODS
Four children experienced their first tumour recurrence at respectively 3, 8, 50 and 59 months after the initial treatment. New neurosurgical attempts to remove the recurring tumour, and in one patient a second course of radiotherapy, were performed, but there were two or more recurrences in these children, resulting in further restriction of surgical or radiotherapeutical possibilities. Chemotherapy was given, consisting of five intravenous ambulatory courses of Adriamycin (doxorubicin) (33 mg/m2/day, continuously over 3 days) together with oral CCNU (lomustine) (80 mg/m2 at day 1) at 6-weeks intervals.


RESULTS
After the chemotherapy there was no further tumour recurrence after 12, 10, 3 and 3 years respectively. In the third patient a cystic relapse occurred after 3 years' remission. In the fourth patient a complete regression was observed of the cystic part of the tumour. The side-effects of the chemotherapy consisted of alopecia and bone marrow depression. No signs of cardiomyopathy have been found.


CONCLUSIONS
Treatment of recurrent craniopharyngioma in children by chemotherapy with anthracyclines and nitrourea-derivates may be effective.
Lippens
R J
RJ
Department of Paediatric Neurology, University Hospital, St Radboud, Nijmegen, The Netherlands.
Rotteveel
J J
JJ
Otten
B J
BJ
Merx
H
H
D000293:Adolescent; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003397:Craniopharyngioma / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery; D004317:Doxorubicin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007223:Infant; D008130:Lomustine / Q000627:therapeutic use*; D008297:Male; D009364:Neoplasm Recurrence, Local; D010911:Pituitary Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery; D014057:Tomography, X-Ray Computed
D000970:Antineoplastic Agents; D008130:Lomustine; D004317:Doxorubicin