INTRODUCTION: The majority of craniopharyngioma (CF) have a cystic component and only 10% are completely solid. In tumors with a large cystic component, stereotactic drainage or instillation of radioctive and/or chemotherapeutic agents have been used. Only several authors have reported the use of bleomycin for the treatment of cystic CF. CASE REPORT: The authors present the case of a nineteen years old patient with a recurrent cystic CF who was treated with intratumoral injections of bleomycin. The patient had been operated on three times before because of regrowth of the tumor. This last time he had a severe disturbance of his visual acuity and a huge regrowth of the cystic CF. An intracystic catheter stereotactically placed was connected to an Ommaya reservoir and, after assuring the impermeability of the cyst, bleomycin was administered through the reservoir up to a total dose of 45mg distributed in six doses. No complications were detected during and after the procedure. A MR performed 4 months after treatment showed a clear reduction in the size of the cyst but 10 months later a new regrowth of the cyst was detected by MR with no new signs or symptoms. A total dose of 30 mg divided in six doses was administered. No complications occurred. The MR 18 months after the first treatment showed the reduction in size of the tumor. The ophtalmological study showed almost normal visual acuity in both eyes. DISCUSSION: Although there is not an stablished protocol for the indication and the form of application of intracystic bleomycin, results with this treatment for cystic CF seem good in the literature. However, the risk of local complications after the administration of intratumoural bleomycin in these patients is around 10%, and some fatal toxic reactions have been recently reported. CONCLUSION: Intracystic administration of bleomycin is a valid option as adjuvant therapy for CF in patients with recurrences that are not surgical candidates because of the high risk of complications. The role of bleomycin as a primary treatment for CF and treatment protocols remain to be stablished with additional studies.
INTRODUCTION: The majority of craniopharyngioma (CF) have a cystic component and only 10% are completely solid. In tumors with a large cystic component, stereotactic drainage or instillation of radioctive and/or chemotherapeutic agents have been used. Only several authors have reported the use of bleomycin for the treatment of cystic CF. CASE REPORT: The authors present the case of a nineteen years old patient with a recurrent cystic CF who was treated with intratumoral injections of bleomycin. The patient had been operated on three times before because of regrowth of the tumor. This last time he had a severe disturbance of his visual acuity and a huge regrowth of the cystic CF. An intracystic catheter stereotactically placed was connected to an Ommaya reservoir and, after assuring the impermeability of the cyst, bleomycin was administered through the reservoir up to a total dose of 45mg distributed in six doses. No complications were detected during and after the procedure. A MR performed 4 months after treatment showed a clear reduction in the size of the cyst but 10 months later a new regrowth of the cyst was detected by MR with no new signs or symptoms. A total dose of 30 mg divided in six doses was administered. No complications occurred. The MR 18 months after the first treatment showed the reduction in size of the tumor. The ophtalmological study showed almost normal visual acuity in both eyes. DISCUSSION: Although there is not an stablished protocol for the indication and the form of application of intracystic bleomycin, results with this treatment for cystic CF seem good in the literature. However, the risk of local complications after the administration of intratumoural bleomycin in these patients is around 10%, and some fatal toxic reactions have been recently reported. CONCLUSION: Intracystic administration of bleomycin is a valid option as adjuvant therapy for CF in patients with recurrences that are not surgical candidates because of the high risk of complications. The role of bleomycin as a primary treatment for CF and treatment protocols remain to be stablished with additional studies.
Authors: Stewart Goldman; Ian F Pollack; Regina I Jakacki; Catherine A Billups; Tina Y Poussaint; Adekunle M Adesina; Ashok Panigrahy; Donald W Parsons; Alberto Broniscer; Giles W Robinson; Nathan J Robison; Sonia Partap; Lindsay B Kilburn; Arzu Onar-Thomas; Ira J Dunkel; Maryam Fouladi Journal: Neuro Oncol Date: 2020-11-26 Impact factor: 12.300
Authors: John-Paul Kilday; Massimo Caldarelli; Luca Massimi; Robert Hsin-Hung Chen; Yi Yen Lee; Muh-Lii Liang; Jeanette Parkes; Thuran Naiker; Marie-Lise van Veelen; Erna Michiels; Conor Mallucci; Benedetta Pettorini; Lisethe Meijer; Christian Dorfer; Thomas Czech; Manuel Diezi; Antoinette Y N Schouten-van Meeteren; Stefan Holm; Bengt Gustavsson; Martin Benesch; Hermann L Müller; Anika Hoffmann; Stefan Rutkowski; Joerg Flitsch; Gabriele Escherich; Michael Grotzer; Helen A Spoudeas; Kristian Azquikina; Michael Capra; Rolando Jiménez-Guerra; Patrick MacDonald; Donna L Johnston; Rina Dvir; Shlomi Constantini; Meng-Fai Kuo; Shih-Hung Yang; Ute Bartels Journal: Neuro Oncol Date: 2017-10-01 Impact factor: 12.300