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Poor quality of life persists after pituitary tumor surgery
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Individuals with adult-onset craniopharyngioma reported postoperative quality of life measures that were comparable with those of other primary and secondary brain tumors, despite the benign biology of the condition, according to an analysis of German registry data published in The Journal of Clinical Endocrinology & Metabolism.
“Adult craniopharyngioma, contrary to child-onset craniopharyngioma, has not yet received the attention it deserves since patients suffering from this ‘benign’ tumor are severely limited in their quality of life comparable to patients with more aggressive tumor diseases,” Klaus Christian Mende, MD, a neurosurgical resident in the department of neurosurgery at Hamburg University Medical Center, Germany, told Endocrine Today. “Patients have to be monitored and specific support offers should be identified to allow the return to a successful work and family environment, where the patients can resume the role they had before knowing of their disease.”
Mende and colleagues analyzed data from 148 individuals with adult-onset craniopharyngioma, identified at eight centers participating in the German Craniopharyngioma Registry for Adults, a collaborative project of the pituitary working group of the German Society for Endocrinology (22 identified prospectively; 126 retrospectively; mean age at diagnosis, 46 years; 50% women). All participants completed the European Organization for the Research and Treatment of Cancer quality of life questionnaires, modules C30 (general health) and BN20 (quality of life for patients with brain tumors). Researchers followed patients for a mean of 31 months to assess surgical complications, symptoms, BMI and quality of life preoperatively and at follow-up.
Within the cohort, primary surgery was performed between March 1983 and January 2018, with 81 participants treated by transcranial surgery, 54 by transsphenoidal microsurgery and eight by endoscopy. Median tumor size was 12.5 cm (n = 82).
Researchers found that complications were more frequent after transcranial vs. transsphenoidal approaches (31% vs. 11%; P < .01). Preoperative obesity was present in 38% of all adamantinomatous craniopharyngiomas (P = .05), whereas diabetes insipidus was more frequent for papillary craniopharyngioma (36.8% vs. 16.7%; P < .05). Hormone deficits at follow-up were reduced in 16.9% of participants, increased in 63.6% and remained unchanged in 31.4% (P < .001).
BMI increased from a mean 28.7 kg/m² before surgery to a mean 30.2 kg/m² at follow-up (P < .001).
After surgery, researchers observed improvements for three quality of life metrics between baseline and follow-up: “future uncertainty” (62.5 vs. 36.8; P = .01), visual disorders (38.9 vs. 12; P = .009) and headaches (mean, 57.8 vs. 25; P = .007). There were no changes for other quality of life metrics.
“Craniopharyngioma even ranked worse concerning impairment from bladder control (probably diabetes insipidus-related), drowsiness and itchy skin during follow-up,” the researchers wrote. “Overall, patients did, even after successful treatment, not return to comparable life-quality scores as a healthy patient collective.”
The researchers noted that early psychosocial interventions are required to establish a high level of quality of life, adding that the role of obesity “remains to be defined,” and a special focus should be placed on surgical strategy and preservation of hypothalamic function to reduce this effect.
“In order to better understand the relevant problems in adult craniopharyngioma, we require longitudinal studies that can adequately monitor the disease progression and identify the problems arising therein,” Mende said. – by Regina Schaffer
For more information:
Klaus Christian Mende, MD, can be reached at Hamburg University Medical Center, Department of Neurosurgery, Martinistrasse 52, 20246, Hamburg, Germany; email: c.mende@uke.de.
Disclosures: Sandoz provided an unrestricted grant to fund the registry. The authors report no relevant financial disclosures.
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