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Brachytherapy in paediatric craniopharyngiomas: a systematic review and meta-analysis of recent literature

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Abstract

Purposes

Brachytherapy has been indicated as an alternative option for treating cystic craniopharyngiomas. Despite the difficulties regarding the complex nuclear infrastructure and consequent small number of brachytherapy studies, recent discoveries relating tumour characteristics to sensitivity to brachytherapy have stimulated this extensive systematic review and meta-analysis of the recent results aiming to summarise its efficacy and complications.

Methods

The systematic review was structured using PRISMA statements. The MEDLINE database was systematically reviewed from March 2010 to February 2021 to identify qualified trials dealing with radioisotope brachytherapy in cystic craniopharyngiomas in the paediatric population, emphasising tumour control rates and complications.

Results

A total of 228 individuals were analysed, of which 66 were children. The minimum average follow-up was 5 years. Considering the paediatric trials, partial and complete responses were achieved in 89% of patients with exclusively cystic lesions, compared to 58% in non-exclusively cystic lesions. The former observed progression in 3% of patients, while in the latter, 35% was reported. Visual and endocrine improvement reached 64% and 20%, respectively, in the first group, in contrast to 48% and 7% in the second group, respectively. There were similar results considering the non-exclusive paediatric series, but with less expressive numbers.

Conclusion

These results reinforce the positive impact of radioisotope brachytherapy in the treatment of predominant monocystic or multicystic craniopharyngiomas, especially in the paediatric population, grounded by impressive tumour control rates, lower morbidities and single application in the majority of the cases. In the future, specific morphological tumour characteristics might be considered for a more assertive patient selection.

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References

  1. Cossu G, Jouanneau E, Cavallo LM et al (2020) Surgical management of craniopharyngiomas in adult patients: a systematic review and consensus statement on behalf of the EANS skull base section. Acta Neurochir 162:1159–1177. https://doi.org/10.1007/s00701-020-04265-1

    Article  PubMed  Google Scholar 

  2. Iannalfi A, Fragkandrea I, Brock J, Saran F (2013) Radiotherapy in craniopharyngiomas. Clin Oncol 25(11):654–667. https://doi.org/10.1016/j.clon.2013.07.005

    Article  CAS  Google Scholar 

  3. Alexandraki KI, Kaltsas GA, Karavitaki N, Grossman AB (2009) The medical therapy of craniopharyngiomas: the way ahead. J Clin Endocrinol Metab 104(12):5751–5764. https://doi.org/10.1210/jc.2019-01299. (PMID: 31369091)

    Article  Google Scholar 

  4. Bogusz A, Muller HL (2018) Childhood-onset craniopharyngioma: latest insights into pathology, diagnostics, treatment, and follow-up. Expert Rev Neurother 18(10):793–806. https://doi.org/10.1080/14737175.2018.1528874

    Article  CAS  PubMed  Google Scholar 

  5. Karavitaki N (2014) Management of craniopharyngiomas. J Endocrinol Invest 37(3):219–228. https://doi.org/10.1007/s40618-013-0050-9

    Article  CAS  PubMed  Google Scholar 

  6. Müller HL, Merchant TE, Puget S, Martinez-Barbera JP (2017) New outlook on the diagnosis, treatment and follow-up of childhood-onset craniopharyngioma. Nat Rev Endocrinol 13(5):299–312. https://doi.org/10.1038/nrendo.2016.217

    Article  PubMed  Google Scholar 

  7. Sterkenburg AS, Hoffmann A, Gebhardt U, Warmuth-Metz M, Daubenbüchel AM, Müller HL (2015) Survival, hypothalamic obesity, and neuropsychological/psychosocial status after childhood-onset craniopharyngioma: newly reported long-term outcomes. Neuro Oncol 17(7):1029–1038. https://doi.org/10.1093/neuonc/nov044

    Article  PubMed  PubMed Central  Google Scholar 

  8. Bartels U, Laperriere N, Bouffet E, Drake J (2012) Intracystic therapies for cystic craniopharyngioma in childhood. Front Endocrinol 3:1–2. https://doi.org/10.3389/fendo.2012.00039

    Article  Google Scholar 

  9. Cáceres A (2005) Intracavitary therapeutic options in the management of cystic craniopharyngioma. child's nervous system 21(8–9):705–718. https://doi.org/10.1007/s00381-005-1227-0

  10. Mrowczynski OD, Langan ST, Rizk EB (2018) Craniopharyngiomas: a systematic review and evaluation of the current intratumoral treatment landscape. Clin Neurol Neurosurg 166:124–130. https://doi.org/10.1016/j.clineuro.2018.01.039

    Article  PubMed  Google Scholar 

  11. Moussa AH, Kerasha AA, Mahmoud ME (2013) Surprising outcome of ommaya reservoir in treating cystic craniopharyngioma: a retrospective study. Br J Neurosurg 27(3):370–373. https://doi.org/10.3109/02688697.2012.741732

    Article  CAS  PubMed  Google Scholar 

  12. Spaziante R, De Divitiis E, Irace C, Cappabianca P, Caputi F (1989) Management of primary or recurring grossly cystic craniopharyngioma by means of draining system. Acta Neurochir (Wein) 97(3–4):95–106

    Article  CAS  Google Scholar 

  13. Chang H, Zhang J, Cao W, Wang Y, Zhao H, Liu R, Guo S (2018) Drug distribution and clinical safety in treating cystic craniopharyngiomas using intracavitary radiotherapy with phosphorus-32 colloid. Oncol Lett 15(4):4997–5003. https://doi.org/10.3892/ol.2018.7981

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Denis-Bacelar AM, Romanchikova M, Chittenden S, Saran FH, Mandeville H, Du Y, Flux GD (2013) Patient-specific dosimetry for intracavitary 32P-chromic phosphate colloid therapy of cystic brain tumors. Eur J Nucl Med Mol Imaging 40(10):1532–1541. https://doi.org/10.1007/s00259-013-2451-6

    Article  CAS  PubMed  Google Scholar 

  15. Enriquez-Marulanda A, Sierra-Ruiz M, Pabón LM, Lobato-Polo J (2016) Intracavitary irradiation as a safe alternative for cystic craniopharyngiomas: case report and review of the literature. Case Rep Med 2016:3601395. https://doi.org/10.1155/2016/3601395

    Article  PubMed  PubMed Central  Google Scholar 

  16. Leksell L (1951) The stereotaxic method and radiosurgery of the brain. Acta Chir Scand 102(4):316–319

    CAS  PubMed  Google Scholar 

  17. Babaei M, Ghahramani-Asl R, Sadoughi H, Sardari D, Shahzadi S (2018) Evaluation of Bremsstrahlung radiation dose in stereotactically radiocolloid therapy of cystic craniopharyngioma tumors with 32P radio-colloid. Australas Phys Eng Sci Med 41(3):697–771. https://doi.org/10.1007/s13246-018-0665-4

    Article  PubMed  Google Scholar 

  18. Hasegawa T, Kondziolka D, Hadjipanayis CG, Lunsford LD (2004) Management of cystic craniopharyngiomas with phosphorus-32 intracavitary irradiation. Neurosurgery 54(4):813–20; discussion 820–2. https://doi.org/10.1227/01.neu.0000114262.30035.af

  19. Hu C, Chen J, Meng Y, Zhang J, Wang Y, Liu R, Yu X (2018) Phosphorus-32 interstitial radiotherapy for recurrent craniopharyngioma. Medicine 97(26):11136–11140. https://doi.org/10.1097/md.0000000000011136

    Article  Google Scholar 

  20. Julow JV (2012) Intracystic irradiation for craniopharyngiomas. Pituitary 16(1):34–45. https://doi.org/10.1007/s11102-012-0442-4

    Article  Google Scholar 

  21. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzche PC, Ioannidis JPA, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA Statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6(7):e1000100. https://doi.org/10.1371/journal.pmed.1000100

    Article  PubMed  PubMed Central  Google Scholar 

  22. Hozo SP, Djubegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5(1):1–10. https://doi.org/10.1186/1471-2288-5-13

    Article  Google Scholar 

  23. Salkind N (2010) Encyclopedia of Research Design. SAGE Publications, Inc

  24. Barriger RB, Chang A, Lo SS, Timmerman RD, Desrosiers C, Boaz JC, Fakiris AJ (2011) Phosphorus-32 therapy for cystic craniopharyngiomas. Radiotherapy And Oncology 98(2):207–212. https://doi.org/10.1016/j.radonc.2010.12.001

    Article  CAS  PubMed  Google Scholar 

  25. Maarouf M, Majdoub FE, Fuetsch M, Hoevels M, Lehrke R, Berthold F, Voges J, Sturm V (2015) Stereotactic intracavitary brachytherapy with P-32 for cystic craniopharyngiomas in children. Strahlenther Onkol 192(3):157–165. https://doi.org/10.1007/s00066-015-0910-7

    Article  PubMed  Google Scholar 

  26. Pollock BE, Lunsford LD, Kondziolka D, Levine G, Flickinger JC (1995) Phosphorus-32 intracavitary irradiation of cystic craniopharyngiomas: current technique and long-term results. Int J Radiat Oncol Biol Phys 33(2):437–446. https://doi.org/10.1016/0360-3016(95)00175-X

    Article  CAS  PubMed  Google Scholar 

  27. Vanhauwaert D, Hallaert G, Baert E, Van Roost D, Okito JP, Caemaert J (2013) Treatment of cystic craniopharyngioma by endocavitary instillation of yttrium90 radioisotope–still a valuable treatment option. J Neurol Surg Part A Cent Eur Neurosurg 74(5):307–312. https://doi.org/10.1055/s-0033-1341413

    Article  Google Scholar 

  28. Kickingereder P, Maarouf M, Majdoub FE, Fuetsch M, Lehrke R, Wirths J, Luyken K, Schomaecker K, Treuer H, Voges J (2012) Intracavitary brachytherapy using stereotactically applied phosphorus-32 colloid for treatment of cystic craniopharyngiomas in 53 patients. Journal of Neurooncology 109(2):365–374. https://doi.org/10.1007/s11060-012-0902-8

    Article  CAS  Google Scholar 

  29. Yu X, Zhang J, Liu R, Wang Y, Wang H, Wang P, Chen J, Liu S (2015) Interstitial radiotherapy using phosphorus-32 for giant posterior fossa cystic craniopharyngiomas. J Neurosurg Pediatr 15(5):510–518. https://doi.org/10.3171/2014.10.peds14302

    Article  PubMed  Google Scholar 

  30. Zhao R, Deng J, Liang X, Zeng J, Chen X, Wang J (2010) Treatment of cystic craniopharyngioma with phosphorus-32 intracavitary irradiation. Childs Nerv Syst 26(50):669–674. https://doi.org/10.1007/s00381-009-1025-1

    Article  PubMed  Google Scholar 

  31. Ansari SF, Moore RJ, Boaz JC, Fulkerson DH (2016) Efficacy of phosphorus-32 brachytherapy without external-beam radiation for long-term tumor control in patients with craniopharyngioma. J Neurosurg Pediatr 17(4):439–445. https://doi.org/10.3171/2015.8.peds15317

    Article  PubMed  Google Scholar 

  32. Backlund EO (1989) Colloidal radioisotopes as part of a multi-modality treatment of craniopharyngiomas. J Neurosurg Sci 33(1):95–97

    CAS  PubMed  Google Scholar 

  33. Backlund EO, Axelsson B, Bergstrand CG et al (1989) Treatment of craniopharyngioma: the stereotactic approach in a ten to twenty-three years’ perspective. I. Surgical, radiological and ophthalmological aspects. Acta Neurochir (Wien) 99:11–19

    Article  CAS  Google Scholar 

  34. Backlund EO (1994) Treatment of craniopharyngiomas: the multimodality approach. Pediatr Neurosurg 21(Suppl 1):82–89. https://doi.org/10.1159/000120867

    Article  PubMed  Google Scholar 

  35. Julow JV, Backlund EO, Lányi F, Hajda M, Bálunt K, Nyáry I, Szeifert GT (2007) Long-term resuts and late complications after intracavitary ytrium-90 colloid irradiation of recurrent cystic craniopharyngiomas. Neurosurgery 61(2):288–296. https://doi.org/10.1227/01.neu.0000255528.68963.ef

    Article  PubMed  Google Scholar 

  36. Van den Berge JH, Blaauw G, Breeman WA, Rahmy A, Wijngaarde R (1992) Intracavitary brachytherapy of cystic craniopharyngiomas. J Neurosurg 77(4):545–550. https://doi.org/10.3171/jns.1992.77.4.0545

    Article  PubMed  Google Scholar 

  37. Voges J, Sturm V, Lehrke R, Treuer H, Gauss C, Berthold F (1997) Cystic craniopharyngioma: long-term results after intracavitary irradiation with stereotactically applied colloidal beta- emitting radioactive sources. Neurosurgery 40(2):263–269. https://doi.org/10.1097/00006123-199702000-00006

    Article  CAS  PubMed  Google Scholar 

  38. Derrey S, Blond S, Reyns N, Touzet G, Carpentier P, Gauthier H, Dhellemmes P (2008) Management of cystic craniopharyngiomas with stereotactic endocavitary irradiation using colloidal 186Re: a retrospective study of 48 consecutive patients. Neurosurgery 63(6):1045–52; discussion 1052–3. https://doi.org/10.1227/01.NEU.0000335786.10968.2F

  39. Kiehna EN, Merchant TE (2010) Radiation therapy for pediatric craniopharyngioma. Neurosurg Focus 28(4):10–14. https://doi.org/10.3171/2010.1.focus09297

    Article  Google Scholar 

  40. Wijnen M, van den Heuvel-Eibrink MM, Janssen JAMJL, Catsman-Berrevoets CE, Michiels EMC, van Veelen-Vincent MC, Dallenga AHG, van den Berge JH, van Rij CM, van der Lely AJ, Neggers SJCMM (2017) Very long-term sequelae of craniopharyngioma. Eur J Endocrinol 176(6):755–767. https://doi.org/10.1530/EJE-17-0044

    Article  CAS  PubMed  Google Scholar 

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Funding

The researcher funded the cost related to statistical analysis and English translation. There were no other costs.

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Authors and Affiliations

  1. Department of Neurosurgery, Hospital das Clínicas, School of Medicine, University of São Paulo, Street Eneas de Carvalho, 155, Pinheiros, São Paulo, Brazil

    M. Mazzuia Guimarães, D. Dante Cardeal, M. Jacobsen Teixeira, J. Erasmo Dal Col Lucio, F. Hada Sanders, R. Kei Kuromoto & H. Matushita

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  1. M. Mazzuia Guimarães
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Correspondence to M. Mazzuia Guimarães.

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Guimarães, M.M., Cardeal, D.D., Teixeira, M.J. et al. Brachytherapy in paediatric craniopharyngiomas: a systematic review and meta-analysis of recent literature. Childs Nerv Syst 38, 253–262 (2022). https://doi.org/10.1007/s00381-021-05378-3

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