Maeher R Grewal, Daniel B Spielman, Chetan Safi, Jonathan B Overdevest, Marc Otten, Jeffrey Bruce, David A Gudis
{"title":"Gross Total Versus Subtotal Surgical Resection in the Management of Craniopharyngiomas.","authors":"Maeher R Grewal, Daniel B Spielman, Chetan Safi, Jonathan B Overdevest, Marc Otten, Jeffrey Bruce, David A Gudis","doi":"10.1177/2152656720964158","DOIUrl":null,"url":null,"abstract":"<p><p>Craniopharyngiomas (CP) are suprasellar tumors that can grow into vital nearby structures and thus cause significant visual, endocrine, and hypothalamic dysfunction. Debate persists as to the optimal treatment strategy for these benign lesions, particularly with regards to the extent of surgical resection. The goals of tumor resection are to eliminate the compressive effect of the tumor on surrounding structures and minimize recurrence. It remains unclear whether a gross total resection (GTR) or subtotal resection (STR) with adjuvant therapy confers a better prognosis. Chemotherapy and radiation therapy (RT) have been explored as both neoadjuvant and adjuvant treatments to decrease tumor burden and prevent recurrence. The objective of this paper is to review the risks and benefits of GTR versus STR, specifically with regard to risk of recurrence and postoperative morbidity. Aggregated data suggest that STR monotherapy is associated with higher rates of recurrence relative to GTR (50.6% ± 22.1% vs 20.2% ± 13.5%), while STR combined with RT leads to recurrence rates similar to GTR. However, both GTR and RT are independently associated with higher rates of comorbidities including panhypopituitarism, diabetes insipidus, and visual deficits. The treatment strategy for CPs should ultimately be tailored to each patient's individual tumor characteristics, risk, symptoms, and therapeutic goals.</p>","PeriodicalId":45192,"journal":{"name":"Allergy & Rhinology","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2020-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/2152656720964158","citationCount":"17","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Allergy & Rhinology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/2152656720964158","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2020/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"OTORHINOLARYNGOLOGY","Score":null,"Total":0}
引用次数: 17
Abstract
Craniopharyngiomas (CP) are suprasellar tumors that can grow into vital nearby structures and thus cause significant visual, endocrine, and hypothalamic dysfunction. Debate persists as to the optimal treatment strategy for these benign lesions, particularly with regards to the extent of surgical resection. The goals of tumor resection are to eliminate the compressive effect of the tumor on surrounding structures and minimize recurrence. It remains unclear whether a gross total resection (GTR) or subtotal resection (STR) with adjuvant therapy confers a better prognosis. Chemotherapy and radiation therapy (RT) have been explored as both neoadjuvant and adjuvant treatments to decrease tumor burden and prevent recurrence. The objective of this paper is to review the risks and benefits of GTR versus STR, specifically with regard to risk of recurrence and postoperative morbidity. Aggregated data suggest that STR monotherapy is associated with higher rates of recurrence relative to GTR (50.6% ± 22.1% vs 20.2% ± 13.5%), while STR combined with RT leads to recurrence rates similar to GTR. However, both GTR and RT are independently associated with higher rates of comorbidities including panhypopituitarism, diabetes insipidus, and visual deficits. The treatment strategy for CPs should ultimately be tailored to each patient's individual tumor characteristics, risk, symptoms, and therapeutic goals.
颅咽管瘤(CP)是一种鞍上肿瘤,可生长到重要的附近结构,从而引起严重的视觉、内分泌和下丘脑功能障碍。关于这些良性病变的最佳治疗策略,特别是关于手术切除的程度,争论仍然存在。肿瘤切除的目的是消除肿瘤对周围结构的压迫作用,减少复发。目前尚不清楚是总全切除(GTR)还是次全切除(STR)配合辅助治疗能获得更好的预后。化疗和放疗(RT)作为新辅助和辅助治疗已被探索,以减轻肿瘤负担和预防复发。本文的目的是回顾GTR与STR的风险和益处,特别是关于复发和术后发病率的风险。综合数据显示,STR单药治疗的复发率高于GTR(50.6%±22.1% vs 20.2%±13.5%),而STR联合RT的复发率与GTR相似。然而,GTR和RT都独立与更高的合并症发生率相关,包括全垂体功能低下、尿囊症和视力缺陷。CPs的治疗策略最终应根据每个患者的个体肿瘤特征、风险、症状和治疗目标进行调整。