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Recurrence of Craniopharyngiomas« Back to Volume 22, Issue 4, December 2006 - Table of Contents Karavitaki and colleagues retrospectively assessed the effect of growth hormone (GH) replacement upon recurrence of craniopharyngioma in patients. Data of all patients who presented with a craniopharyngioma to the Departments of Endocrinology or Paediatrics in Oxford, United Kingdon, between January 1964 and July 2005 were evaluated. Thirty two patients (22 males, 10 females) received GH treatment for a mean period of 6.3 ± 4.6 years; 21 started treatment during childhood (13 of them continued treatment with an adult dose of GH after achieving final height), 11 started GH treatment during adult life. Mean duration of follow up, from surgery to the last assessment was 10.8 ± 9.2 years. As controls, 53 subjects who had not received GH therapy (30 men, 23 women) were followed for a period of 8.3 ± 8.8 years. During the observation period 4 patients treated with GH and 22 non-GH treated subjects developed tumor recurrence. The researchers reported GH was not a significant independent predictor of recurrence after adjusting for sex, age at tumor diagnosis, duration of GH treatment, and type of tumor therapy (ie, gross total removal, partial removal, surgery with irradiation). Based on the information obtained from this craniopharyngioma database, the authors concluded, there is no evidence that GH replacement is associated with an increased risk of tumor recurrence. Editor’s CommentCraniopharyngiomas are common epithelial tumors that account for 2% to 5% of all primary intracranial neoplasms in adults and 5.6% to 13% of intracranial tumors in children. Despite their being histologically benign, these tumors tend to recur even after successful therapy; these tumors result in significant morbidity and mortality due to the damage caused by the tumor itself or to the adverse effects of surgery and/or irradiation. GH deficiency is found in 54% to100% of children and adults with craniopharyngiomas. GH and insulin-like growth factor (IGF)-I may play an important role in the genesis and growth of various tumors. Concerns on the safety of GH treatment in patients with craniopharyngiomas, and on the potential of GH treatment increasing the tumor recurrence rate, clearly exist. In a fairly large series of patients who were followed for a prolonged period of time (after surgical intervention for craniopharyngioma) Karavitaki et al found no evidence of GH replacement being associated with an increased risk of tumor recurrence. After adjusting for age at tumor diagnosis, type of tumor, duration of GH treatment, or sex of the patient, GH treatment was not a significant independent predictor of recurrence. Previous data assessing the risk of tumor recurrence in patients with craniopharyngiomas showed similar findings.1,2 These prior studies were mainly limited to large databases in children and may have had limitations due to selection bias, lack of a control group of non-GH treated patients, and a relatively short follow-up. This is the first study to report on the outcome of children with a craniopharyngioma, followed after its surgical removal, treatment with GH until final height, and continued on GH replacement as an adult. It is therefore reassuring to see that both databases in children and in adults seem to indicate that GH treatment is safe and does not lead to an increase in the risk of recurrence in patients with craniopharyngiomas. Roberto Lanes, MD References - (linked to
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Volume 24 Number 1
May 2008
www.GGHjournal.com
ISSN 1932-9032
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