Postoperative MR imaging surveillance of pediatric craniopharyngioma: new institutional guidelines
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ORIGINAL ARTICLE
Postoperative MR imaging surveillance of pediatric craniopharyngioma: new institutional guidelines Mohammed A. Fouda 1,2,3
&
Emily L. Day 1 & Steven J. Staffa 4 & R. Michael Scott 1 & Karen J. Marcus 5,6 & Lissa C. Baird 1,6
Received: 3 August 2020 / Accepted: 22 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To develop postoperative surveillance protocols that yield efficient detection rates of tumor recurrence or progression using fewer imaging studies and less cost. Method This is a retrospective cohort study of all pediatric craniopharyngioma patients who have been diagnosed and treated at Boston Children’s Hospital (BCH) between 1990 and 2017. All statistical analyses were performed using Stata. Results Eighty patients (43 males and 37 females) fulfilled the inclusion criteria. The mean age at time of diagnosis was 8.6 ± 4.4 years. The mean follow-up period was 10.9 ± 6.5 years. Overall 30/80 (37.5%) patients experienced tumor recurrence/progression. The median latency to recurrence/progression was 12.75 months (range 3 to 108 months), with 76.6% of the recurrences/ progressions taking place within the first 2 years postoperatively. Given the lack of any clinical symptoms/signs associated with the vast majority of the recurrent/progressed cases, we propose postoperative MR imaging surveillance protocols that are substantially less intensive than the current practice. Therefore, we recommend the following postoperative MR imaging surveillance protocols, stratified by management strategies; 0, 9, 15, 36, 48, and 60 months for patients who underwent GTR, 0, 3, 6,12, 18, and 24 months for patients who underwent STR alone and 0, 3, 12, 72, 96, and 120 months for patients who underwent STR followed by subsequent XRT. Conclusion The proposed postoperative MR imaging surveillance protocols would provide a potential 50% decrement of healthcare costs. It may also minify the psychological burden of frequent MR scanning for these patients and their families. Keywords Pediatric . Craniopharyngioma . Recurrence . MRI . Surveillance . Protocols
Introduction * Mohammed A. Fouda [email protected] 1
Department of Neurosurgery, Boston Children’s Hospital, Boston, MA, USA
2
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
3
Department of Neurosurgery, Minimally Invasive Neurosurgery Lab–Carnegie Center for Surgical Innovation, Johns Hopkins University–School of Medicine, Baltimore, MD, USA
4
Division of Biostatistics, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA
5
Division of Radiation Oncology, Boston Children’s Hospital, Boston, MA, USA
6
Dana Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA, USA
Craniopharyngiomas are benign, epithelial neoplasms, arising from embryological remnants of the squamous epithelium of the primitive pharynx [10–12] and classically located in the sellar and suprasellar regions [2, 5]. The optimal m
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