Chemotherapy for Craniopharyngiomas in Children

Treatment

Chemotherapy for craniopharyngiomas is a consideration, particularly in young patients with a single cyst and small solid component. It is administered via ommaya reservoir, ensuring no previous leakage.

• Intracystic bleomycin: 2–5 mg 3 times/week, up to 12 doses in a course (23). Usually, each patient received only one course; however, some had a repeat course at time of recurrence.
• Intracystic interferon alpha-2b: 3 million IU 3 times/week for a total of 12 doses (4, 6).
• Intracystic chemotherapy only temporizes: Most patients require more definitive therapy later; the use of radiotherapy has been delayed successfully by several years in some cases (22).

Adjuvant Therapy

• Radiation: Involved field, stereotactic or proton beam, if possible, have been used to manage craniopharyngiomas.

Complications

• Bleomycin: Peritumoral edema leading to deterioration in level of consciousness, infarction, pituitary dysfunction, deterioration in vision, hypothalamic dysfunction requiring supportive care, and two toxic deaths have been reported (23).
• Interferon: Fatigue, arthritis, headache, and depression have all been reported (6). These complications were managed with symptomatic therapy.

Outcome

• Bleomycin: The median PFS was 1.8 years (0.3–6.1 years). In 11/17 patients a sustained benefit was observed for >1year; the median delay for need of an additional therapy in this group was 3.6 years (1.6–9.3 years) (23).
• Interferon: Disease control was achieved in 78% of 60 patients treated. 81% of 37 patients evaluated had a cyst reduction of greater than 50% (4)