The Experts below are selected from a list of 318 Experts worldwide ranked by ideXlab platform
A Gautier - One of the best experts on this subject based on the ideXlab platform.
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Markers of recurrence and long-term morbidity in Craniopharyngioma: a systematic analysis of 171 patients.
Journal of Clinical Endocrinology and Metabolism, 2012Co-Authors: A Gautier, Ariane Godbout, Catherine Grosheny, Isabelle Tejedor, Mathieu Coudert, Carine Courtillot, Christel Jublanc, Marc De Kerdanet, Jean-yves Poirier, Laurent RiffaudAbstract:CONTEXT: Craniopharyngiomas are often associated with an unfavorable prognosis, but data on their long-term consequences are sparse. OBJECTIVE: The aim of the study was to identify markers of recurrence and factors associated with compromised social rehabilitation and altered quality of life in a large cohort of patients with either childhood-onset (CO) or adult-onset Craniopharyngioma. METHODS: Retrospective analysis was performed for 171 patients treated for Craniopharyngioma in two academic centers in France between 1972 and 2009. For each subject, data were collected concerning clinical presentation, imaging features, visual sequelae, endocrine and metabolic impact, treatment modalities (surgery, radiotherapy), recurrence-free survival rate, and social insertion, as well as answers to the WHO-QOL BREF questionnaire. RESULTS: A total of 65 CO and 106 adult-onset patients were reviewed. If CO was diagnosed before the age of 10 yr, this was associated with a higher incidence of obesity, blindness, and panhypopituitarism, and only 40.7% of subjects had adequate work or school attendance compared to 72.4% of patients with later disease onset. Initial symptoms of intracranial hypertension (SIHT), pterional surgery, and multiple surgery were associated with obesity and poorer social insertion. No determinant of quality of life was identified. In the subgroup of patients treated in the 1990s and later, the progression rate was 59.4% in patients with residual tumor on magnetic resonance imaging compared with a 19.8% recurrence rate in the group with apparently complete resection. Recurrence/progression correlates significantly with male gender, early onset (before 10 yr), and SIHT, but only SIHT at presentation remained a significant predictor with multivariate analysis. CONCLUSIONS: Craniopharyngioma continues to be associated with severe outcomes. Higher morbidity rates are found in patients with early-onset disease (before 10 yr), initial SIHT, or in whom pterional surgery was required. Markers of recurrence are difficult to identify, with SIHT being the most powerful predictor.
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markers of recurrence and long term morbidity in Craniopharyngioma a systematic analysis of 171 patients
The Journal of Clinical Endocrinology and Metabolism, 2012Co-Authors: A Gautier, Ariane Godbout, Catherine Grosheny, Isabelle Tejedor, Mathieu Coudert, Carine Courtillot, Christel Jublanc, Marc De KerdanetAbstract:Context: Craniopharyngiomas are often associated with an unfavorable prognosis, but data on their long-term consequences are sparse. Objective: The aim of the study was to identify markers of recurrence and factors associated with compromised social rehabilitation and altered quality of life in a large cohort of patients with either childhood-onset (CO) or adult-onset Craniopharyngioma. Methods: Retrospective analysis was performed for 171 patients treated for Craniopharyngioma in two academic centers in France between 1972 and 2009. For each subject, data were collected concerning clinical presentation, imaging features, visual sequelae, endocrine and metabolic impact, treatment modalities (surgery, radiotherapy), recurrence-free survival rate, and social insertion, as well as answers to the WHO-QOL BREF questionnaire. Results: A total of 65 CO and 106 adult-onset patients were reviewed. If CO was diagnosed before the age of 10 yr, this was associated with a higher incidence of obesity, blindness, and pa...
Peter E Manley - One of the best experts on this subject based on the ideXlab platform.
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multiplexed immunofluorescence reveals potential pd 1 pd l1 pathway vulnerabilities in Craniopharyngioma
Neuro-oncology, 2018Co-Authors: Shannon Coy, Rumana Rashid, Jiaren Lin, Andrew M Donson, Todd C Hankinson, Nicholas K Foreman, Peter E ManleyAbstract:Background Craniopharyngiomas are neoplasms of the sellar/parasellar region that are classified into adamantinomatous Craniopharyngioma (ACP) and papillary Craniopharyngioma (PCP) subtypes. Surgical resection of Craniopharyngiomas is challenging, and recurrence is common, frequently leading to profound morbidity. BRAF V600E mutations render PCP susceptible to BRAF/MEK inhibitors, but effective targeted therapies are needed for ACP. We explored the feasibility of targeting the programmed cell death protein 1/programmed death-ligand 1 (PD-1/PD-L1) immune checkpoint pathway in ACP and PCP. Methods We mapped and quantified PD-L1 and PD-1 expression in ACP and PCP resections using immunohistochemistry, immunofluorescence, and RNA in situ hybridization. We used tissue-based cyclic immunofluorescence to map the spatial distribution of immune cells and characterize cell cycle and signaling pathways in ACP tumor cells which intrinsically express PD-1. Results All ACP (15 ± 14% of cells, n = 23, average ± SD) and PCP (35 ± 22% of cells, n = 18) resections expressed PD-L1. In ACP, PD-L1 was predominantly expressed by tumor cells comprising the cyst lining. In PCP, PD-L1 was highly expressed by tumor cells surrounding the stromal fibrovascular cores. ACP also exhibited tumor cell-intrinsic PD-1 expression in whorled epithelial cells with nuclear-localized beta-catenin. These cells exhibited evidence of elevated mammalian target of rapamycin (mTOR) and mitogen-activated protein kinase (MAPK) signaling. Profiling of immune populations in ACP and PCP showed a modest density of CD8+ T cells. Conclusions ACP exhibit PD-L1 expression in the tumor cyst lining and intrinsic PD-1 expression in cells proposed to comprise an oncogenic stem-like population. In PCP, proliferative tumor cells express PD-L1 in a continuous band at the stromal-epithelial interface. Targeting PD-L1 and/or PD-1 in both subtypes of Craniopharyngioma might therefore be an effective therapeutic strategy.
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sleep dysfunction in long term survivors of Craniopharyngioma
Journal of Neuro-oncology, 2012Co-Authors: Mark W. Kieran, Peter E Manley, Kiera Mckendrick, Megan Mcgillicudy, Susan N Chi, Laurie E Cohen, Sanjeev V KothareAbstract:Craniopharyngiomas are slow growing tumors of the sellar and parasellar region and may also involve the hypothalamus. Treatment involves maximal surgical excision or subtotal resection followed by focal radiation therapy. Late effects of treatment include endocrinopathies, cognitive deficits, behavioral changes, obesity and sleep dysfunction. We conducted a retrospective review of all patients with Craniopharyngioma more than 2 years off treatment and who were evaluated in the neuro-oncology survivorship clinic between 2003 and 2007. Clinical data, extent of resection, treatment modalities, endocrine status, patient symptom report and sleep study results were collected to evaluate the presence of patient reported daytime sleepiness and sleep disturbance and to determine possible risk factors. 28 patients were identified (25 %) female. 19/28 self-reported daytime fatigue or sleep disturbance; this included 4/6 patients with gross total resection and 15/22 with subtotal resection. 16/22 patients treated with cranial irradiation reported sleep-related abnormalities, compared to 3/6 patients who did not receive radiation. All but one patient had pituitary dysfunction requiring hormonal replacement. Patients with more than ≥2 sleep related complaints had a higher BMI (44.6 vs. 32.6, p = 0.0192). 8 patients underwent formal sleep evaluation. 3 patients had documented central or obstructive sleep apnea. The mean arousal index was 11.0/h (normal <5). Two patients were treated with melatonin for sleep disturbance and 2 were treated with stimulants for excessive daytime sleepiness. A majority of patients with Craniopharyngioma have self-reported daytime fatigue and/or sleep dysfunction after treatment. Extent of resection did not increase the likelihood of patient-reported daytime sleepiness and/sleep dysfunction; however, patients who received radiation more frequently reported daytime sleepiness and/or sleep dysfunction. Patients with a higher BMI were more likely to experience sleep disturbance. Formal sleep evaluations should be considered in all patients with Craniopharyngioma.
Nalin Gupta - One of the best experts on this subject based on the ideXlab platform.
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a systematic review of the results of surgery and radiotherapy on tumor control for pediatric Craniopharyngioma
Childs Nervous System, 2013Co-Authors: Aaron J Clark, Tene A Cage, Derick Aranda, Andrew T Parsa, Peter P Sun, Kurtis I Auguste, Nalin GuptaAbstract:Objective Craniopharyngiomas are rare tumors with bimodal incidence in the pediatric and adult age groups. Treatment strategies range from aggressive resection to planned limited resection combined with adjuvant therapies. Currently there is no consensus for standard of care for pediatric Craniopharyngioma.
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treatment related morbidity and the management of pediatric Craniopharyngioma a systematic review
Journal of Neurosurgery, 2012Co-Authors: Aaron J Clark, Tene A Cage, Derick Aranda, Andrew T Parsa, Kurtis I Auguste, Nalin GuptaAbstract:Object Craniopharyngiomas are benign tumors but their close anatomical relationship with critical neurological, endocrine, and vascular structures makes gross-total resection (GTR) with minimal morbidity difficult to achieve. Currently, there is controversy regarding the extent, timing, and modality of treatment for pediatric Craniopharyngioma. Methods The authors performed a systematic review of the published literature on pediatric Craniopharyngioma to determine patterns of clinical practice and the reported outcomes of standard treatment strategies. This yielded 109 studies, which contained data describing extent of resection for a total of 531 patients. Differences in outcome were examined based upon extent of resection and choice of radiation treatment. Results Gross-total resection was associated with increased rates of new endocrine dysfunction (OR 5.4, p < 0.001), panhypopituitarism (OR 7.8, p = 0.006), and new neurological deficits (OR 9.9, p = 0.03) compared with biopsy procedures. Subtotal rese...
Andrew T Parsa - One of the best experts on this subject based on the ideXlab platform.
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a systematic review of the results of surgery and radiotherapy on tumor control for pediatric Craniopharyngioma
Childs Nervous System, 2013Co-Authors: Aaron J Clark, Tene A Cage, Derick Aranda, Andrew T Parsa, Peter P Sun, Kurtis I Auguste, Nalin GuptaAbstract:Objective Craniopharyngiomas are rare tumors with bimodal incidence in the pediatric and adult age groups. Treatment strategies range from aggressive resection to planned limited resection combined with adjuvant therapies. Currently there is no consensus for standard of care for pediatric Craniopharyngioma.
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treatment related morbidity and the management of pediatric Craniopharyngioma a systematic review
Journal of Neurosurgery, 2012Co-Authors: Aaron J Clark, Tene A Cage, Derick Aranda, Andrew T Parsa, Kurtis I Auguste, Nalin GuptaAbstract:Object Craniopharyngiomas are benign tumors but their close anatomical relationship with critical neurological, endocrine, and vascular structures makes gross-total resection (GTR) with minimal morbidity difficult to achieve. Currently, there is controversy regarding the extent, timing, and modality of treatment for pediatric Craniopharyngioma. Methods The authors performed a systematic review of the published literature on pediatric Craniopharyngioma to determine patterns of clinical practice and the reported outcomes of standard treatment strategies. This yielded 109 studies, which contained data describing extent of resection for a total of 531 patients. Differences in outcome were examined based upon extent of resection and choice of radiation treatment. Results Gross-total resection was associated with increased rates of new endocrine dysfunction (OR 5.4, p < 0.001), panhypopituitarism (OR 7.8, p = 0.006), and new neurological deficits (OR 9.9, p = 0.03) compared with biopsy procedures. Subtotal rese...
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Craniopharyngioma a comparison of tumor control with various treatment strategies
Neurosurgical Focus, 2010Co-Authors: Isaac Yang, Derick Aranda, Michael E Sughrue, Martin J Rutkowski, Rajwant Kaur, Michael E Ivan, Igor J Barani, Andrew T ParsaAbstract:Object Craniopharyngiomas have a propensity to recur after resection, potentially causing death through their aggressive local behavior in their critical site of origin. Recent data suggest that subtotal resection (STR) followed by adjuvant radiotherapy (XRT) may be an appealing substitute for gross-total resection (GTR), providing similar rates of tumor control without the morbidity associated with aggressive resection. Here, the authors summarize the published literature regarding rates of tumor control with various treatment modalities for Craniopharyngiomas. Methods The authors performed a comprehensive search of the English language literature to identify studies publishing outcome data on patients undergoing surgery for Craniopharyngioma. Rates of progression-free survival (PFS) and overall survival (OS) were determined through Kaplan-Meier analysis. Results There were 442 patients who underwent tumor resection. Among these patients, GTR was achieved in 256 cases (58%), STR in 101 cases (23%), and S...
Marc De Kerdanet - One of the best experts on this subject based on the ideXlab platform.
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Markers of recurrence and long-term morbidity in Craniopharyngioma: a systematic analysis of 171 patients.
Journal of Clinical Endocrinology and Metabolism, 2012Co-Authors: A Gautier, Ariane Godbout, Catherine Grosheny, Isabelle Tejedor, Mathieu Coudert, Carine Courtillot, Christel Jublanc, Marc De Kerdanet, Jean-yves Poirier, Laurent RiffaudAbstract:CONTEXT: Craniopharyngiomas are often associated with an unfavorable prognosis, but data on their long-term consequences are sparse. OBJECTIVE: The aim of the study was to identify markers of recurrence and factors associated with compromised social rehabilitation and altered quality of life in a large cohort of patients with either childhood-onset (CO) or adult-onset Craniopharyngioma. METHODS: Retrospective analysis was performed for 171 patients treated for Craniopharyngioma in two academic centers in France between 1972 and 2009. For each subject, data were collected concerning clinical presentation, imaging features, visual sequelae, endocrine and metabolic impact, treatment modalities (surgery, radiotherapy), recurrence-free survival rate, and social insertion, as well as answers to the WHO-QOL BREF questionnaire. RESULTS: A total of 65 CO and 106 adult-onset patients were reviewed. If CO was diagnosed before the age of 10 yr, this was associated with a higher incidence of obesity, blindness, and panhypopituitarism, and only 40.7% of subjects had adequate work or school attendance compared to 72.4% of patients with later disease onset. Initial symptoms of intracranial hypertension (SIHT), pterional surgery, and multiple surgery were associated with obesity and poorer social insertion. No determinant of quality of life was identified. In the subgroup of patients treated in the 1990s and later, the progression rate was 59.4% in patients with residual tumor on magnetic resonance imaging compared with a 19.8% recurrence rate in the group with apparently complete resection. Recurrence/progression correlates significantly with male gender, early onset (before 10 yr), and SIHT, but only SIHT at presentation remained a significant predictor with multivariate analysis. CONCLUSIONS: Craniopharyngioma continues to be associated with severe outcomes. Higher morbidity rates are found in patients with early-onset disease (before 10 yr), initial SIHT, or in whom pterional surgery was required. Markers of recurrence are difficult to identify, with SIHT being the most powerful predictor.
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markers of recurrence and long term morbidity in Craniopharyngioma a systematic analysis of 171 patients
The Journal of Clinical Endocrinology and Metabolism, 2012Co-Authors: A Gautier, Ariane Godbout, Catherine Grosheny, Isabelle Tejedor, Mathieu Coudert, Carine Courtillot, Christel Jublanc, Marc De KerdanetAbstract:Context: Craniopharyngiomas are often associated with an unfavorable prognosis, but data on their long-term consequences are sparse. Objective: The aim of the study was to identify markers of recurrence and factors associated with compromised social rehabilitation and altered quality of life in a large cohort of patients with either childhood-onset (CO) or adult-onset Craniopharyngioma. Methods: Retrospective analysis was performed for 171 patients treated for Craniopharyngioma in two academic centers in France between 1972 and 2009. For each subject, data were collected concerning clinical presentation, imaging features, visual sequelae, endocrine and metabolic impact, treatment modalities (surgery, radiotherapy), recurrence-free survival rate, and social insertion, as well as answers to the WHO-QOL BREF questionnaire. Results: A total of 65 CO and 106 adult-onset patients were reviewed. If CO was diagnosed before the age of 10 yr, this was associated with a higher incidence of obesity, blindness, and pa...