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At least 703 records · Page 39Linked to original sources
PubMed1979

A long-term postoperative follow-up in craniopharyngioma.

The long-term postoperative follow-up of children treated for craniopharyngioma is influenced by the patient's age at time of diagnosis, tumor location, texture, interface and adherence to brain, and achievements of the first operation. These factors will be examined as they apply to 51 children treated at the Hospital for Sick Children, Toronto. A brief comment on the role of irradiation treatment is also provided.

Adolescent↗
PubMed1989

Prognostic factors and results of surgery and postoperative irradiation in the management of pituitary adenomas.

Prognostic factors and results of therapy were analyzed in a retrospective examination of 121 patients with pituitary adenomas treated with surgery and postoperative irradiation (RT) from January 1954 through December 1982 at the Radiation Oncology Center, Mallinckrodt Institute of Radiology. The 10-year overall and disease-free survival for all patients was 85.1 and 89.4%. The expected survival for an age-, gender-, and race-matched population was not significantly distinct at 85.3% (p = 0.72). Follow-up of 94 surviving patients ranged from 3.4 to 29.5 years (mean, 11.7). Statistical analysis was performed for multiple prognostic factors including age, race, gender, disease bulk, visual field symptoms, disease type, surgical approach, and irradiation dose and volume. The only prognostic variable identified by univariate analysis to significantly alter disease-free survival was irradiation dose. Patients receiving 5000-5400 cGy had a tumor control rate of 94.1% (64/68) compared to 85.0% (17/20) for 4000-4999 cGy, 75.0% (18/24) for 3000-3999 cGy, and 28.6% (2/7) for less than 3000 cGy (p = 0.000059). Factors evaluated but established to be insignificant were age, race, gender, disease bulk, visual field symptoms, disease type, surgical approach, and irradiated volume. The 10-year disease-free survival by classification was 93.3% for patients with amenorrhea/galactorrhea, 89.9% for non-functioning adenomas, and 76.4% for acromegaly (p = 0.21). Overall improvement in visual field defects subsequent to treatment occurred in 48.4% (44/91) of those with visual field defects before RT and was significantly correlated with RT dose. The median time to progression of disease was 10.2 years with the last failure occurring at 25 years following the fulfillment of RT. Severe complications related to RT were apparent in 1.7% (2/121). None were known to have endured brain radionecrosis. Serious surgical complications occurred in 9.9% (12/121).

Adenoma↗
PubMed1989

[Stereoradiotherapy of small brain lesions].

Stereoradiotherapy is the stereotaxy guided high-dose irradiation of small (less than 3 cm) intracerebral lesions. Its aim is to induce necrosis or sclerosis inside the target volume. Several techniques permit us to obtain a steep dose gradient between the lesion and the adjacent healthy cerebral parenchyma. They use minibeams (diameter less than 3 cm) of different types of radiations: protons (Kjellberg from Harvard, since 1962); gamma rays of cobalt 60 (Leksell from Stockholm, since 1968); and X-rays from a linear accelerator (Betti from Buenos-Aires, since 1982). The most commonly treated lesions are arterio-venous malformations, hypophyseal adenomas and low grade parenchymatous tumors. The stereotaxic technique is the only means by which to insure that these high dose irradiations, administered in a single session, are actually delivered to the small lesions situated in the cerebral parenchyma.

Adenoma↗
PubMed1998

Growth hormone status in adults treated for acute lymphoblastic leukaemia in childhood.

OBJECTIVE: Growth hormone status was assessed in a cohort of 32 (16 male) adults who had received cranial irradiation (XRT) in childhood as part of their treatment for acute lymphoblastic leukaemia (ALL) and compared with 35 age matched young adults (18 male). DESIGN: Height and weight were measured in all subjects and the heights of the patients at XRT were obtained from their case notes. Each patient and control underwent two provocative tests of growth hormone (GH) secretion using insulin (0.2 IU/kg body weight) and arginine (20 g/m2). Basal serum insulin like growth factor-1 (IGF-1) and IGFBP-3 (binding protein-3) concentrations were also measured. RESULTS: The patient group had a significantly lower peak GH response to both provocative tests (P < 0.01), and lower IGF-1 and IGFBP-3 levels compared with the normal controls (P < 0.01). Nine of the patient group were severely GH deficient (peak GH response < 9 mU/l to both provocative agents) and a further 12 patients were GH insufficient (peak GH response < 20 mU/l to both tests with at least one peak GH response > 9 mU/l). Overall a significant median change in height from XRT to final height of -0.5 SDS was found which was even greater in the severely GH deficient group (median change in height of -2.1 SDS). CONCLUSION: These data suggest that a significant proportion of adults treated with cranial XRT in childhood with irradiation doses between 18-25 Gy, as part of their treatment for ALL, are severely GH deficient now and should be considered for GH replacement. Changes in GH secretion evolve with time following irradiation-induced damage to the hypothalamic-pituitary axis; therefore long-term surveillance will be required in those remaining patients, in whom GH status is considered currently to be insufficient or even normal.

Adolescent↗
PubMed1978

Recent advances in diagnosis and management of galactorrhea.

Using prolactin suppression (L-dopa) and provocative (thorazine) tests along with the clomid test the intactness of hypothalamico-pituitary axis was assessed in a group of eight patients with galactorrhea syndrome. Pituitary neoplasm was suspected in three cases on the basis of elevated plasma prolactin and its abnormal response to L-dopa, thorazine, and clomid tests. Trans-sphenoidal exploration of the pituitary gland in these three cases confirmed the diagnosis. In these cases, however, the commonly used parameters for evaluation of the pituitary gland (skull X ray, visual field measurement, echoencephalogram, etc.) failed to reveal the presence of the pituitary lesions. In two of the three cases, normal menses recurred following extirpation of the tumors and conception was achieved successfully. In the remaining patient the operation failed to remove the entire pituitary lesion and it was necessary to irradiate the pituitary gland as the patient continued to have persistent galactorrhea and hyperprolactinemia. The importance of the prolactin assay, and its response to stimulation and suppression tests for proper evaluation of galactorrhea was fully discussed.

Adult↗
PubMed1998

[Late sequelae of oncologic treatment in children].

The risk of late effects of cancer treatment in children is higher than that after treatment during adulthood. The late effects of chemotherapy are proportional to the dosage and those of irradiation to the size of the radiation field, fractionation and dose. Irradiation may lead to impaired growth of bone and soft tissues, cranial irradiation to pituitary deficiencies, alopecia and impaired cognitive function, irradiation of the neck to altered thyroid function, thoracic irradiation to diminished pulmonary function and cardiovascular morbidity, radiation therapy of the abdomen to infertility in females, impaired renal function and chronic enteritis. Chemotherapy-induced damage is more organ-specific. Well-known cardiotoxic agents are the anthracycline derivatives. Restricted pulmonary function is seen after treatment with bleomycin and nitrourea derivatives. Several antineoplastic agents are gonadotoxic in men. Nephrotoxic agents are cisplatin and ifosfamide. The cumulative relative risk of developing a second primary neoplasm is 3,8-6,9 after a follow-up period of 25 years. Alkylating agents and the topoisomerase inhibitors are known to increase the risk of haematologic malignancy, while radiation therapy is associated with bone, soft tissue, thyroid, breast, brain and gastrointestinal malignancies.

Adolescent↗
PubMed1994

Craniopharyngioma: results of survey of the American Society of Pediatric Neurosurgery.

The best management of craniopharyngioma in children remains a controversial subject for pediatric neurosurgeons. The results of a survey completed by 11 pediatric neurosurgeons documenting outcome in 139 children is presented. There were 21 children treated with limited surgery and irradiation with a good outcome in 83%. One hundred twelve underwent an attempt at gross total resection, 30 of whom required irradiation. There was a marked difference in good outcome according to experience of surgeon, 87 vs. 52% in the radical surgery group.

Adolescent↗
PubMed1994

The role of radiation therapy in the treatment of craniopharyngioma.

The role of radiotherapy in the management of patients with craniopharyngiomas is still controversial. Many articles have been published reviewing retrospective patient information with subsequent treatment recommendations which are not randomized and are biased. Treatment at the University of California, San Francisco, with radiation and surgery yields a 10-year disease-free survival of 77%. No difference in overall survival was found based on sex, age, or type of surgery. A review of the literature shows that radiation added to surgery results in a 50-80% disease-free survival. Patients undergoing a complete resection may be observed for subsequent recurrence. If a subtotal resection or biopsy is obtained, that patient should be irradiated with modern techniques to a dose of 5,400 cGy at 180 cGy/fraction.

Adolescent↗
PubMed1994

Advances in radiation therapy for craniopharyngiomas.

The overall survival for patients with craniopharyngioma is excellent. However, conventional treatments that include aggressive surgery and standard irradiation have been associated with significant morbidity. Focal radiation treatment with stereotactic radiosurgery has a role in selected cases, but may also be damaging to sensitive normal tissues such as the optic chiasm. Stereotactic radiotherapy (SRT) is a technique that allows for conventionally fractionated radiation under stereotactic guidance. Thus, highly focal and precise radiotherapy is now coupled with fractionation, enabling the treatment of selected tumors with a potentially improved therapeutic index. Dose optimization with SRT for focally discrete tumors should result in equivalent local control and survival compared to patients treated with conventional irradiation. We anticipate a significant decrease in late effects, especially neuropsychological and neuroendocrine sequelae.

Child↗
PubMed1994

Surgical management of recurrent craniopharyngiomas.

Recurrence is the most common complication of all forms of treatment of craniopharyngioma. Reoperation is the preferred treatment for unsuspected residual tumor after primary radical resection. Surgical resection can be curative in the majority of recurrences, especially those with solid tumor. Scarring from previous surgery, particularly following primary radical removal, may increase the technical difficulty of surgery. Although most patients will have a reasonable functional outcome, the morbidity following operation for recurrence is greater than primary surgery with some degree of new deficit being common. Adjuvant irradiation, interstitial irradiation or bleomycin, and serial aspiration of cystic tumors have lower cure rates than surgical resection but may have lower morbidity in selected patients. They are potential adjuvant or second-line treatments for subsequent recurrence.

Child↗