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Craniopharyngioma

 

 

Late Effects

After treatment for a craniopharyngioma there are many chronic health problems to be aware of and to screen for in long-term survivors of this disease:

These long term health risks are due to:

  • Disease:
    • Cysts can compress optic apparatus and nerves
    • Infiltration of adjacent tissue by scarring and fibrosis
  • Therapy:
    • Radiation therapy (RT) induced damage and scarring
    • Radical surgery can be associated with significant morbidity
    • Intra-cystic bleomycin (late effects debated)

 

Summary of Late Effects after treatment for craniopharyngioma:

Late Toxicity

Neurocognitive problems:

  • Poor short term memory
  • Difficulty with executive function

Depression:

  • Usually related to multiple long-term health problems and neurocognitive dysfunction

Seizures:

  • Side effect of scarring related to tumor and previous RT therapy
  • Responds to anticonvulsant therapy

Visual problems:

  • The disease itself may exert pressure on the optic apparatus leading to optic atrophy, decreased vision and field defects
  • RT may directly damage the optic nerves and chiasm.
  • RT can cause cataracts (lens of the eye very sensitive to low dose RT)

Pituitary and hypothalamic dysfunction:

  • Often children with craniopharyngiomas present with pituitary insufficiency. RT therapy will make this situation worse.
  • Increased risk of Metabolic syndrome (with hypertension)
  • BLOOD PRESSURE SHOULD BE CHECKED IN ANY PATIENT WHO HAS A HISTORY OF CRANIAL RT
  • GH deficiency is universal with failure to grow in children.  Also risk of other hormone deficiencies:
  • TSH deficiency
  • LH/FSH deficiency
  • ACTH deficiency
  • During infection, surgery and illness craniopharyngioma survivors are very likely to need support with extra steroid medication
  • These patients should be followed by an endocrinologist on a yearly basis who should supervise their replacement therapy.

 

Increased risk for cerebrovascular events (strokes):

  • RT effect on cerebral vasculature
  • Significantly increased risk of TIAs and cerebrovascular disease in these patients

Increased risk of second neoplasms:

Cranial RT techniques more than 10 years old could be associated with scattered RT to the thyroid with an increased risk of:

 

NB: Craniopharyngioma is a chronic disease and the tumor requires intermittent imaging over many years as the cystic component of the tumor can sometimes increase in size after therapy and require treatment.
 

 

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