scholarly journals The Detection, Outcome, and Presentation of Twin-Twin Transfusion Syndrome in Monochorionic Diamniotic Twin Pregnancies Followed with a Protocol of Fortnightly Ultrasound Examination

2021 ◽  
pp. 1-8
Author(s):  
Isabel Couck ◽  
Sophie Ponnet ◽  
Liesbeth Thewissen ◽  
Francesca Russo ◽  
Jan Deprest ◽  
...  
Keyword(s):  
Time Window ◽  
Common Knowledge ◽  
Survival Rates ◽  
Stage Iii ◽  
Entire Cohort ◽  
Ultrasound Findings ◽  
Twin Pregnancies ◽  
Unselected Cohort ◽  
Scan Protocol

<b><i>Background:</i></b> Evidence to support a fortnightly scan protocol for monochorionic diamniotic (MCDA) pregnancies to detect twin-twin transfusion syndrome (TTTS) is scarce. Also, TTTS-related mortality in an unselected cohort is not well documented. Finally, common knowledge suggests that a more frequent follow-up may pick up the disease at a milder stage, but little is known on the ultrasound findings before the diagnosis. <b><i>Objectives:</i></b> We examine if a fortnightly ultrasound scan from 16 weeks onward detects TTTS in time. Also, we document the outcomes in a large unselected cohort of MCDA twins and examine the ultrasound findings within 14 days before diagnosis. <b><i>Methods:</i></b> Retrospective cohort of 675 MCDA twin pregnancies followed with a fortnightly scan protocol from 16 weeks onward. Timely detection of TTTS was defined as before fetal demise (stage V), ruptured membranes, or a dilated cervix. We compared the ultrasound findings before the diagnosis between stage I–II and stage III–IV. <b><i>Results:</i></b> A total of 82/675 (12%) pregnancies developed TTTS, of which 74/82 (90%) were detected in time. In 8/82 (10%), TTTS was diagnosed in stage V: 5 before 16 weeks and 2 after 26 weeks. Fetoscopic laser photocoagulation (FLP) of the placental anastomoses was performed in 48/82 (59%). The survival of TTTS in the entire cohort was 105/164 (64%). In contrast, survival after FLP was 77/96 (80%). In 16/19 (84%) of stage III–IV TTTS, abnormal Doppler findings preceded the diagnosis of TTTS. <b><i>Conclusions:</i></b> A scheme of fortnightly ultrasound scans from 16 weeks onward detects 9 out of ten TTTS pregnancies in time. Most stage V cases presented outside the typical time window of 16 and 26 weeks. Survival rates after FLP underestimate the mortality of TTTS. Most stage III–IV cases have abnormal Doppler findings before the diagnosis of TTTS.

scholarly journals The Prognosis and Oncological Predictor of Urachal Carcinoma of the Bladder: A Large Scale Multicenter Cohort Study Analyzed 203 Patients With Long Term Follow-Up

2021 ◽  
Vol 11 ◽  
Author(s):  
Young Dong Yu ◽  
Young Hwii Ko ◽  
Jong Wook Kim ◽  
Seung Il Jung ◽  
Seok Ho Kang ◽  
...  
Keyword(s):  
Large Scale ◽  
Survival Rates ◽  
Stage Iii ◽  
Pathological Stage ◽  
Urachal Carcinoma ◽  
Multicenter Cohort ◽  
Long Term Follow Up ◽  
The Mean

AimThis study evaluated the prognosis and survival predictors for bladder urachal carcinoma (UC), based on large scale multicenter cohort with long term follow-up database.MethodsA total 203 patients with bladder UC treated at 19 hospitals were enrolled. Clinical parameters on carcinoma presentation, diagnosis, and therapeutic methods were reviewed for the primary cancer and for all subsequent recurrences. The stage of UC was stratified by Mayo and Sheldon pathological staging system. Oncological outcomes and the possible clinicopathological parameters associated with survival outcomes were investigated.ResultsThe mean age of the patients was 54.2 years. Among the total of 203 patients, stages I, II, III, and IV (Mayo stage) were 48 (23.8%), 108 (53.5%), 23 (11.4%), and 23 (11.4%), respectively. Gross hematuria and bladder irritation symptoms were the two most common initial symptoms. The mean follow-up period was 65 months, and 5-year overall survival rates (OS), cancer-specific survival rates (CSS), and recurrence-free survival rates (RFS) were 88.3, 83.1, and 63.9%, respectively. For the patients with Mayo stage ≥III, OS, CSS, and RFS were significantly decreased to 38.0, 35.2, and 28.4%, respectively. The higher pathological stage (Mayo stage ≥III, Sheldon stage ≥IIIc), positive surgical margin (PSM), and positive lymphovascular invasion (PLM) were independent predictors of shorter OS, CSS, and RFS.ConclusionThe pathological stage, PSM, and PLM were significantly associated with the survival of UC patients, emphasizing an importance of the complete surgical resection of tumor lesion.

scholarly journals Improvement in childhood cancer survival in Lithuania over three decades

2020 ◽  
Vol 27 (1) ◽  
pp. 1-9
Author(s):  
Jelena Rascon ◽  
Giedrė Smailytė
Keyword(s):  
Childhood Cancer ◽  
Cancer Survival ◽  
Survival Rates ◽  
Population Based ◽  
Early Years ◽  
University Hospital ◽  
Entire Cohort ◽  
Background Population ◽  
Childhood Cancer Survival

Background. Population-based EUROCARE-5 studies demonstrated that childhood cancer survival rates in Lithuania were 10–20% lower than the European mean. We aimed to analyse the change in the outcome of treatment of paediatric malignancies in Lithuania over 30 years. Methods. A single-centre retrospective analysis of children below 18 years of age treated for cancer at Vilnius University Hospital Santaros Klinikos between 1982 and 2011 was carried out. The minimal requirement of 5-year follow-up after diagnosis was specified for survival estimation. The vital status was assessed using data from the population-based Lithuanian Cancer Registry. To evaluate changes over time, the entire cohort was split into three groups according to the time of diagnosis: 1982–1991, 1992–2001, and 2002–2011. Results. A total of 1268 children met the inclusion criteria. The shortest median follow-up was 8.9 (IQR 6.4–11.5) years for patients treated in the third decade. The 5-year overall survival of the entire cohort increased from 37.3% (95% CI 30.2–44.3) in 1982–1991 to 70.7% (95% CI 66.4–74.1) in 2002–2011 (p < 0.0001). The same trend was evident when calculated separately for leukaemia (p < 0.0001), lymphoma (p < 0.0005), and solid tumours (p < 0.004). The percentage of cure rose from zero in the early years of the period analysed to 80% in 2010 and 2011. The improvement in the treatment outcome was attributable to the reduction of treatment-related mortality from 45.8% in 1982–1991 to 12.4% in 2002–2011 and disease recurrence from 30.4% to 19.6% for the same periods, respectively. Conclusions. Significant progress in the cure rate of children treated for cancer at our institution was observed over 30 years. Collaborative national and international clinical and research efforts are crucial to ensure further advances in care and cure.

scholarly journals Adult patients with supratentorial pilocytic astrocytoma: long-term follow-up of prospective multicenter clinical trial NCCTG-867251 (Alliance)

2015 ◽  
Vol 2 (4) ◽  
pp. 199-204 ◽  
Author(s):  
Paul D. Brown ◽  
S. Keith Anderson ◽  
Xiomara W. Carrero ◽  
Brian P. O'Neill ◽  
Caterina Giannini ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Pilocytic Astrocytoma ◽  
Survival Rates ◽  
Prospective Trial ◽  
Subtotal Resection ◽  
Entire Cohort ◽  
Pilocytic Astrocytomas ◽  
Long Term Follow Up

Abstract Background Pilocytic astrocytoma is a rare tumor in adults. This report is of a prospective clinical trial with long-term follow-up. Methods Between 1986 and 1994, 20 eligible adults with supratentorial pilocytic astrocytomas were enrolled in a prospective intergroup trial of radiotherapy (RT) after biopsy (3 patients) or observation after gross (11 patients) or subtotal (6 patients) resection. Results At the time of analysis (median follow-up, 20.8 years), 2 patients (10%) have died and 18 patients (90%) are alive. Neurologic and cognitive function were stable or improved over time for the majority of patients. No toxic effects of treatment or malignant transformations have been recorded at last follow-up. For the entire cohort the 20-year time to progression and overall survival rates are 95% and 90% respectively. The cause of death (2.2 and 16.1 years after enrollment) in both patients was unrelated to tumor although both were biopsy-only patients. One subtotally resected tumor progressed 1 month after enrollment requiring P32 injection into an enlarging cyst. Because of further progression this patient required RT 18 months later. This patient is alive without evidence of progression 18 years after RT. Conclusion The long-term follow-up results of this prospective trial confirm that adults with pilocytic astrocytomas have a favorable prognosis with regard to survival and neurologic function. Close observation is recommended for adults with pilocytic astrocytomas, reserving RT for salvage, as the majority remain stable after gross or subtotal resection and no adjuvant therapy.

Impact of adding oxaliplatin to fluoropyrimidines in the adjuvant colon cancer: Experience in Ramon y Cajal University Hospital.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 815-815
Author(s):  
Olga Martinez Saez ◽  
Arantzazu Martínez Barquín García ◽  
Maria Villamayor Delgado ◽  
Cristina Saavedra Serrano ◽  
Elena Corral de la Fuente ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Cox Model ◽  
Stage Ii ◽  
University Hospital ◽  
Stage Iii ◽  
Entire Cohort ◽  
Cancer Experience ◽  
Ecog Ps ◽  
Ramón Y Cajal

815 Background: The addition of oxaliplatin to fluorouracil and leucovorin as adjuvant therapy for patients with stage II and III colon cancer (CC) has been analyzed in two large, randomized trials, MOSAIC and C-07 trials. The updated results of these studies showed that the addition of oxaliplatin enhances overall survival by approximately 5% in patients with stage III disease but has no effect in patients with stage II disease. Methods: We retrospectively included patients with stage II and III CC that were operated between 2009 and 2014 in the Ramón y Cajal University Hospital from Madrid. We perform a multivariable Cox model analysis to estimate the benefit of the chemotherapy stratifying by oxaliplatin in each stage. The model was further adjusted by including the following confounders: ECOG-PS, number of removed nodes, perforation, obstruction, grade and age. Stata 13.1 was used to analyze the data. Results: 564 patients were identified (281 stage II and 283 stage III). 305 did not receive any chemotherapy, 61 received monotherapy with fluoropyrimidines (FP) and 198, FP and oxaliplatin. The median follow-up in the entire cohort was 49 months. Globally, adjuvant chemotherapy (either with FP alone or with the combination with oxaliplatin) showed no benefit in DFS (HR of 1.18 and 0.98, respectively). The benefit in OS was significant either for FP alone (HR: 0.46, p: 0.029) and for the combination treatment (HR: 0.41, p: 0.001). Patients with stage II treated with FP in monotherapy showed no benefit, neither in DFS nor OS (HR for DFS: 2.2, p: 0.1; HR for OS: 0.5, p: 0.22). The benefit was neither seen with the addition of oxaliplatin (HR for DFS: 2, p: 0.11; HR for OS: 0.85, p: 0.7). Stage III patients treated with FP presented a HR for DFS of 0.76 (p: 0.5) and a HR for OS of 0.42 (p: 0.087). The HR for DFS with oxaliplatin was 0.53 (p: 0.07). A significant improvement in OS was observed, with a HR of 0.22 (p < 0.001). Conclusions: The addition of oxaliplatin in the adjuvant treatment of stage III patients showed a trend towards improvement in DFS and a significant benefit in OS compared to not receiving chemotherapy. On the contrary, patients with stage II did not benefit from this treatment, neither in DFS nor OS.

Abstract WMP13: The Predictive Value of Volumetric MRI Profiles in Stroke Patients Receiving IV tPA in the 3-Hour Time Window

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Shyian S Jen ◽  
Elizabeth M Sweeney ◽  
Argye E Hillis ◽  
Ciprian M Crainiceanu ◽  
John W Krakauer ◽  
...  
Keyword(s):  
Time Window ◽  
Roc Curves ◽  
Stroke Patients ◽  
Entire Cohort ◽  
Time To Peak ◽  
Increased Risk ◽  
Mri Scans ◽  
The Mean ◽  
Iv Tpa

Background: Recent studies have detected a population of acute ischemic stroke patients whose MRI profile is associated with intracranial hemorrhage (ICH) when treated beyond 3 hours. This so-called malignant profile (MP) supports MRI based selection of patients for treatment. Purpose: To test the hypothesis that there is an MRI based volumetric profile that identifies patients at increased risk of ICH when treated with IV tPA within 3 hours Methods: An analysis was performed on a database of stroke patients provided by the STIR and VISTA Imaging Investigators. 75 patients were identified who had DWI, PWI, and GRE images prior to IV tPA and follow-up imaging to assess for parenchymal hematoma (PH). The pre-tPA MRI scans were analyzed using Matlab software to calculate DWI and PWI volumes. DWI lesions were defined by an ADC threshold of 600. PWI lesions were defined by a time-to-peak threshold of an 8 seconds delay. Follow-up GRE images were reviewed for evidence of PH. ROC curves were generated using thresholds from 1-300mL. Results: 44 of the 75 patients were women with a mean ± stdev age of 70±17. The mean NIHSS was 12±9. The mean time from stroke onset to tPA administration was 147±30 minutes. For the entire cohort, mean lesion volumes were 22±41mL for DWI and 41±42 mL for PWI. 9 patients developed PH. For the PH group, mean lesion volumes were 24±20 mL for DWI and 48±40 mL for PWI. The ROC curves are shown in Figure 1. The areas under the curves are 0.68 for DWI volumes and 0.60 for PWI volumes. The optimal thresholds for predicting PH were 13 mL for DWI with a sensitivity of 0.67 and a specificity of 0.66 and 21 mL for PWI with a sensitivity of 0.78 and a specificity of 0.46. Conclusions: Although DWI volume performed better than PWI volume in predicting PH, neither served as a robust predictor in this population. Although further studies are needed, these results suggest that an MRI profile defined by DWI and PWI volumes in the 0-3 hour window may not be able to reliably guide clinical management.

Updated overall survival (OS) and exploratory analysis from the randomized, phase II EVAN study of erlotinib (E) versus vinorelbine plus cisplatin (NP) as adjuvant therapy in Chinese patients with stage IIIA EGFR+ NSCLC.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 8520-8520
Author(s):  
Dongsheng Yue ◽  
Shi-Dong Xu ◽  
Qun Wang ◽  
Xiaofei Li ◽  
Yi Shen ◽  
...  
Keyword(s):  
Survival Rate ◽  
Randomized Study ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Stage Iii ◽  
Chinese Patients ◽  
Stage Iiia ◽  
Meaningful Improvement ◽  
Whole Exome

8520 Background: The EVAN study of E vs NP in stage III EGFR+ NSCLC has met its primary endpoint and been previously published: 2-year disease-free survival was 81.4% (95% CI, 69.6–93.1) in E group vs 44.6% (95% CI, 26.9-62.4) in NP group (HR, 1.823; 95% CI, 1.194–2.784; P=0.0054). We report 5-year OS and exploratory results from EVAN with a further 43 month follow up (cutoff date: Jan 6, 2021). Methods: Patients with stage IIIA EGFR+ NSCLC were randomized assigned (1:1) into either E arm (n=51, 150mg/day) or NP arm (n=51, vinorelbine 25mg/m2 on day 1, 8 and cisplatin 75mg/m2 on day 1 of a 21-day cycle). In order to explore the relationship between patient benefits and co-occurring variants, 47 patients received whole exome sequencing (WES) analysis (E, n=24; NP, n=23). Results: Median follow-up time was 54.8 months for E and 63.9 months for NP. E improved OS and 5-year survival rate compared with NP in ITT population. The median OS was 84.2m (95% CI, 78.1,-) with E vs 61.1m (95% CI, 39.6-82.1) with NP (HR, 0.318; 95% CI, 0.151-0.670). The 5-year survival rates were 84.8% (95%CI, 72.0-97.6) and 51.1% (95% CI, 34.7-67.5), respectively. In the WES analysis, we found that the most frequent genes with co-occurring variants at baseline were TP53, MUC16, FAM104B, KMT5A and DNAH9, and additional EGFR variants, each with similar prevalence regardless of EGFR-activating mutation subgroup. Moreover, in the erlotinib-treated patients, the SNP mutation of UBXN11 was associated with significantly worse DFS (P=0.0111). Conclusions: This is the first randomized study of EGFR-TKI to demonstrate a clinically meaningful improvement in OS vs chemotherapy in stage III EGFR+ NSCLC (5-year survival rate 84.8% in E vs 51.1% in NP). The co-occurring variants at baseline may be associated with reduced DFS. Further studies are required to confirm our results (EVAN, NCT01683175). Clinical trial information: NCT01683175.

scholarly journals Treatment of Sinonasal Adenocarcinoma: A Population-Based Prospective Cohort Study

2019 ◽  
Vol 81 (06) ◽  
pp. 627-637 ◽  
Author(s):  
Marton König ◽  
Terje Osnes ◽  
Åse Bratland ◽  
Peter Jebsen ◽  
Torstein R. Meling
Keyword(s):  
Prospective Cohort ◽  
Multidisciplinary Treatment ◽  
Survival Rates ◽  
Population Based ◽  
Craniofacial Resection ◽  
Curative Intent ◽  
Term Survival ◽  
Entire Cohort ◽  
Sinonasal Adenocarcinoma

Abstract Objectives Sinonasal adenocarcinoma (AC) is a potentially curable disease despite being an aggressive malignancy. Long-term survival can be achieved with early diagnosis and adequate multidisciplinary treatment. Our goal was to evaluate outcomes for patients with AC treated at our institution. Design In a population-based consecutive prospective cohort, we conducted an analysis of all patients treated for surface epithelial AC between 1995 and 2018. Results Twenty patients were included, and follow-up was 100%. The mean follow-up time was 89 months for the entire cohort (112 months for patients with no evidence of disease). Intestinal-type AC was found in 65%, whereas nonintestinal-type AC was found in 35% of all cases; 75% had stage T3/4 disease. Tumor grade was intermediate/high in 65%. Eighteen patients underwent treatment with curative intent (craniofacial resection [CFR] in 61%, transfacial approach in 39%, adjuvant radiotherapy in 89%), achieving negative margins in 56% of cases. Overall survival (OS) rates were 90, 68, and 54% after 2, 5, and 10 years of follow-up, respectively, and the corresponding disease-specific survival (DSS) rates were 90, 73, and 58%. Age over 60 years, tumor with a maxillary origin, and microscopic bone invasion were negative prognostic factors. Radical CFR was correlated with better OS and DSS. Conclusion The high probability of achieving radicality with CFR, the low complication rate, the acceptable toxicity of modern irradiation modalities, and the promising survival rates indicate that this strategy might be considered a safe and an effective option for treating patients with very advanced sinonasal AC.

scholarly journals Treatment and long-term outcomes in pituitary carcinoma: a cohort study

2019 ◽  
Vol 181 (4) ◽  
pp. 397-407 ◽  
Author(s):  
Fernando Santos-Pinheiro ◽  
Marta Penas-Prado ◽  
Carlos Kamiya-Matsuoka ◽  
Steven G Waguespack ◽  
Anita Mahajan ◽  
...  
Keyword(s):  
Survival Rates ◽  
Multidisciplinary Care ◽  
Pituitary Carcinoma ◽  
High Survival ◽  
Ki 67 ◽  
Entire Cohort ◽  
Prospective Trials ◽  
Multiple Recurrences

Background Pituitary carcinoma (PC) is an aggressive neuroendocrine tumor diagnosed when a pituitary adenoma (PA) becomes metastatic. PCs are typically resistant to therapy and develop multiple recurrences despite surgery, radiotherapy and chemotherapy. Recently, treatment with temozolomide (TMZ) has shown promising results, although the lack of prospective trials limits assessment of benefit. Methods We describe a single-center multidisciplinary experience in managing PC patients over a 22-year period and review previously published PC series. Results Seventeen patients were identified. Median age at PC diagnosis was 44 years (range 16–82 years), and the median time from PA to PC transformation was 5 years (range 1–29 years). Median follow-up time was 28 months. Most PCs were hormone-positive (n = 12): ACTH (n = 5), PRL (n = 4), LH/FSH (n = 2) and GH (n = 1). All patients underwent at least one resection and at least one course of radiation after PC diagnosis. Immunohistochemistry showed high Ki-67 labeling index (>3%) in 10/15 cases. Eight patients (47%) had only central nervous system (CNS) metastases; six (35%) had combined CNS and systemic metastases. The most commonly used chemotherapy was TMZ, and TMZ-based therapy was associated with the longest PFS in 12 (71%) cases, as well as the longest period from PC diagnosis to first progression (median 30 months). The 2, 3 and 5-year survival rate of the entire cohort was 71, 59 and 35%, respectively. All patients surviving >5 years had been treated with TMZ-based therapy. Conclusions PC management benefits from multidisciplinary care and multimodality therapy. TMZ-based regimens were associated with high survival rates and long disease control.

scholarly journals Porous tantalum rod implantation is associated with low survival rates in patients with type C2 osteonecrosis of the femoral head but has no effect on the clinical outcome of conversion total hip arthroplasty: a retrospective study with an average 8-year follow-up

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Mincong He ◽  
Qiushi Wei ◽  
Zhenqiu Chen ◽  
Fan Yang ◽  
Xiaojun Chen ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Survival Rate ◽  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Survival Rates ◽  
Stage Ii ◽  
Stage Iii ◽  
Porous Tantalum

Abstract Background Our study aimed to investigate the clinical outcomes and survival rates following porous tantalum rod surgery (PTRS) and conversion total hip arthroplasty (THA) subsequent to failed PTRS. Methods A total of 38 subjects (40 hips) with osteonecrosis of the femoral head (ONFH) were included in this retrospective study between January 2008 and December 2011. All subjects were evaluated before surgery by using the Association Research Circulation Osseous (ARCO) classification system, the Japan Investigation Committee (JIC) classification and the Harris hip score (HHS). The endpoint of this study was set as final follow-up (including the survival time of PTRS and conversion THA). The rates of radiological progression were also evaluated. Patients who received conversion THA were further followed and compared to a control group of 58 patients with ONFH who underwent primary THA. Results The mean follow-up time was 120.7 ± 9.2 (range, 104–143) months, and the overall survival rate was 75% at 96 months (ARCO stage II: 81.5%; stage III: 38.5%; JIC type C1: 83.3%; C2: 30%). The HHS before surgery was 59 (55–61), in contrast to 94 (91–96) at 96 months follow-up (P < 0.01). HHS in stage III show a significant poorer result compared to stage II at 24 months. HHS in Type C2 group show no significant difference compared to HHS before surgery at 24 and 60 months follow up (P = 0.91, P = 0.30). Twelve hips requiring secondary THA were followed for 66.9 ± 31.7 months, and control hips that underwent primary THA was followed for 75.4 ± 14.9 months. The HHS in the conversion group was 89 (86–93) and that in the primary THA group was 92 (79–95, P = 0.09) at the 5-year follow-up. Conclusion In the mid-term follow-up, porous tantalum implants showed an encouraging survival rate in symptomatic patients in early stages (ARCO stage II) or with limited necrotic lesions (JIC type C1). In addition, our results did not demonstrated any difference between primary THA and conversion THA.

scholarly journals Recurrent craniopharyngioma after conformal radiation in children and the burden of treatment

2015 ◽  
Vol 15 (5) ◽  
pp. 499-505 ◽  
Author(s):  
Paul Klimo ◽  
Garrett T. Venable ◽  
Frederick A. Boop ◽  
Thomas E. Merchant
Keyword(s):  
Tumor Progression ◽  
Perioperative Complications ◽  
Survival Rates ◽  
Disease Status ◽  
Cyst Formation ◽  
Time Interval ◽  
Conformal Radiation Therapy ◽  
Entire Cohort ◽  
First Recurrence

OBJECT In this paper the authors present their experience treating children with recurrent craniopharyngioma who were initially managed with surgery followed by conformal radiation therapy (CRT). METHODS A departmental oncology information system was queried to identify all children (< 18 years old) who received CRT for a craniopharyngioma between 1998 and 2010 (inclusive) and specifically those who experienced tumor progression. For each patient, the authors recorded the type of recurrence (solid, cystic, or both), the time interval to first progression and each subsequent progression, the associated treatment complications, and disease status at last follow-up evaluation. RESULTS Among the 97 patients that met criteria for entry into this study, 18 (18.6%) experienced tumor progression (9 cystic, 3 solid, 6 cystic and solid). The median time to first recurrence was 4.62 years (range 1.81–9.11 years). The subgroup included 6 female and 12 male patients with a median age of 7.54 years (range 3.61–13.83 years). Ten patients experienced first progression within 5 years of CRT. The 5- and 10-year treatment-free survival rates for the entire cohort were 89.0% (95% confidence interval [CI] 80.5%–93.9%) and 76.2% (95% CI 64%–85%), respectively. Seven patients had a single episode of progression and 11 had more than 1. The time interval between each subsequent progression was progressively shorter. The 18 patients underwent 38 procedures. The median follow-up duration for this group was 9.32 years (range 4.04–19.0 years). Three patients died, including 1 from perioperative complications. CONCLUSIONS Craniopharyngioma progression after prior irradiation is exceedingly difficult to treat and local control is challenging despite repeated surgical procedures. Given our results, gross-total resection may need to be the surgical goal at the time of first recurrence, if possible. Decompressing new cyst formation alone has a low rate of long-term success.

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