Intracystic bleomycin for cystic craniopharyngiomas in children (abridged republication of cochrane systematic review).
BACKGROUND
Craniopharyngiomas are the most common benign histological tumors to involve the hypothalamopituitary region in childhood. When the tumor location is unfavorable, a gross total or partial resection followed by radiotherapy is the main treatment option in adults. However, it presents the risk of morbidity, especially for children. Intracystic bleomycin has been used to potentially delay the use of radiotherapy or radical resection to decrease morbidity.


OBJECTIVE
To determine the benefit and harm of intracystic bleomycin vs other treatments for cystic craniopharyngiomas in children.


METHODS
We searched the electronic databases of CENTRAL, MEDLINE/PubMed, and EMBASE/Ovid with prespecified terms. In addition, we searched reference lists of relevant articles and reviews, conference proceedings, and ongoing trial databases.


RESULTS
We could not identify any studies in which the only difference between the treatment groups was the use of intracystic bleomycin. We did identify a randomized, controlled trial comparing intracystic bleomycin with intracystic P (n = 7 children). The trial had a high risk of bias. Survival could not be evaluated. There was no evidence of a significant difference in cyst reduction, neurological status, third nerve paralysis, fever, or total adverse effects between the treatment groups. There was a significant difference in favor of the P group for the occurrence of headache and vomiting.


CONCLUSIONS
Based on the currently available evidence, we are not able to give recommendations for the use of intracystic bleomycin in the treatment of cystic craniopharyngiomas in children. High-quality randomized, controlled trials are needed.
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
Wenke
W
Liu
Yuan
Y
Fang
Bowen
B
Cai
Jianguo
J
Xu
Chao
C
You
Heng
H
Zhang
D000293:Adolescent; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage*; D001761:Bleomycin / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003397:Craniopharyngioma / Q000188:drug therapy*; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010911:Pituitary Neoplasms / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D000903:Antibiotics, Antineoplastic; D001761:Bleomycin