Comparison of Neurocognitive and Quality-of-Life Outcomes in Pediatric Craniopharyngioma Patients Treated with Partial Resection and Radiotherapy Versus Gross-Total Resection Only

Authors

Guillermo Aldave
M Fatih Okcu
Murali Chintagumpala
Lucia Ruggieri
Charles G Minard
Fatema Malbari
Lisa E Mash
Arnold C Paulino
Susan McGovern
Uma Ramaswamy
William Whitehead
Lisa S Kahalley

Publication Date

5-1-2023

Journal

Journal of Neurosurgery: Pediatrics

DOI

10.3171/2022.12.PEDS22367

PMID

36806176

PMCID

PMC10193466

PubMedCentral® Posted Date

2-17-2023

PubMedCentral® Full Text Version

Post-Print

Published Open-Access

yes

Keywords

Humans, Male, Child, Female, Craniopharyngioma, Quality of Life, Pituitary Neoplasms, Proton Therapy, Radiotherapy, Adjuvant, Treatment Outcome, Retrospective Studies, craniopharyngioma, neurocognitive, quality of life, outcomes, pediatrics, tumor, surgical technique

Abstract

OBJECTIVE: The optimal management of pediatric craniopharyngioma patients remains controversial, shifting from radical resection (gross-total resection [GTR]) to a more conservative approach with partial resection/biopsy followed by radiotherapy (PR+RT). To the authors' knowledge, no previous studies have compared neurocognitive and quality-of-life (QOL) outcomes between the two main treatments. In this study, the authors compared changes in intellectual, adaptive, and QOL scores in children treated for craniopharyngioma with GTR and those treated with PR+RT.

METHODS: Patients underwent annual neurocognitive and QOL evaluations for up to 10 years posttreatment, including the Full-Scale IQ, Verbal Comprehension Index (VCI), Perceptual Reasoning Index (PRI), Working Memory Index (WMI), and Processing Speed Index (PSI). Child- and parent-reported QOL scores and adaptive behavior in different domains were assessed. General linear mixed models were used to examine change in scores over time by treatment group with adjustment for significant covariates.

RESULTS: Scores from 43 patients treated between 2009 and 2019 (21 GTR, 22 PR+RT) were examined. Within the PR+RT group, 9 patients had intensity-modulated RT and 13 had proton beam therapy. The treatment groups were similar in sex (44% male) and age (median 7.3 years). There were no significant differences in the trajectory of intellectual functioning or QOL scale scores between the two groups. However, patients who underwent GTR exhibited significant improvement over time in overall adaptive behavior (p = 0.04) and conceptual skills (p = 0.01), which was not observed in patients treated with PR+RT.

CONCLUSIONS: Long-term pediatric craniopharyngioma survivors treated with GTR and PR+RT have similar intellectual function and QOL. Larger studies are needed to explore small but clinically significant differences between the two groups.

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