title: Management and outcome of recurrent adult craniopharyngiomas: an analysis of 42 cases with long-term follow-up.
abstract: OBJECTIVE The treatment of recurrent and residual craniopharyngiomas is challenging. In this study the authors describe their experience with these tumors and make recommendations on their management. METHODS The authors performed an observational study of adult patients (≥ 18 years) with recurrent or residual craniopharyngiomas that were managed at their tertiary center. Retrospective data were collected on demographics and clinical, imaging, and treatment characteristics from patients who had a minimum 2-year follow-up. Descriptive statistics were used and the data were analyzed. RESULTS There were 42 patients (27 male, 15 female) with a mean age of 46.3 ± 14.3 years. The average tumor size was 3.1 ± 1.1 cm. The average time to first recurrence was 3.6 ± 5.5 years (range 0.2-27 years). One in 5 patients (8/42) with residual/recurrent tumors did not require any active treatment. Of the 34 patients who underwent repeat treatment, 12 (35.3%) had surgery only (transcranial, endoscopic, or both), 9 (26.5%) underwent surgery followed by adjuvant radiation therapy (RT), and 13 (38.2%) received RT alone. Eighty-six percent (18/21) had a gross-total (n = 4) or near-total (n = 14) resection of the recurrent/residual tumors and had good local control at last follow-up. One of 5 patients (7/34) who underwent repeat treatment had further treatment for a second recurrence. The total duration of follow-up was 8.6 ± 7.1 years. The average Karnofsky Performance Scale score at last follow-up was 80 (range 40-90). There was 1 death. CONCLUSIONS Based on this experience and in the absence of guidelines, the authors recommend an individualized approach for the treatment of symptomatic or growing tumors. This study has shown that 1 in 5 patients does not require repeat treatment of their recurrent/residual disease and can be managed with a "scan and watch" approach. On the other hand, 1 in 5 patients who had repeat treatment for their recurrence in the form of surgery and/or radiation will require further additional treatment. More studies are needed to best characterize these patients and predict the natural history of this disease and response to treatment.
authors.affiliation: Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada.
authors.forename: Mazda K
authors.initials: MK
authors.lastname: Turel
authors.affiliation: Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada.
authors.forename: Georgios
authors.initials: G
authors.lastname: Tsermoulas
authors.affiliation: Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada.
authors.forename: Lior
authors.initials: L
authors.lastname: Gonen
authors.affiliation: Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada.
authors.forename: George
authors.initials: G
authors.lastname: Klironomos
authors.affiliation: Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada.
authors.forename: Joao Paulo
authors.initials: JP
authors.lastname: Almeida
authors.affiliation: Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada.
authors.forename: Gelareh
authors.initials: G
authors.lastname: Zadeh
authors.affiliation: Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada.
authors.forename: Fred
authors.initials: F
authors.lastname: Gentili
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003397:Craniopharyngioma / Q000000981:diagnostic imaging / Q000601:surgery*; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D010911:Pituitary Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: EEA = endoscopic endonasal approach; GTR = gross-total resection; KPS = Karnofsky Performance Scale; NTR = near-total resection; RT = radiation therapy; STR = subtotal resection; adult; craniopharyngioma; endoscopy; radiation; recurrent; residual; surgery