PDF(Pubmed)
Abstract：
Craniopharyngiomas present unique challenges in surgical management due to their proximity to critical neurovascular structures. This systematic review investigates genetic and immunological markers as potential targets for therapy in craniopharyngiomas, assessing their involvement in tumorigenesis, and their influence on prognosis and treatment strategies. The systematic review adhered to PRISMA guidelines, with a thorough literature search conducted on PubMed, Ovid MED-LINE, and Ovid EMBASE. Employing MeSH terms and Boolean operators, the search focused on craniopharyngiomas, targeted or molecular therapy, and clinical outcomes or adverse events. Inclusion criteria encompassed English language studies, clinical trials (randomized or non-randomized), and investigations into adamantinomatous or papillary craniopharyngiomas. Targeted therapies, either standalone or combined with chemotherapy and/or radiotherapy, were examined if they included clinical outcomes or adverse event analysis. Primary outcomes assessed disease response through follow-up MRI scans, categorizing responses as follows: complete response (CR), near-complete response (NCR), partial response, and stable or progressive disease based on lesion regression percentages. Secondary outcomes included treatment type and duration, as well as adverse events. A total of 891 papers were initially identified, of which 26 studies spanning from 2000 to 2023 were finally included in the review. Two tables highlighted adamantinomatous and papillary craniopharyngiomas, encompassing 7 and 19 studies, respectively. For adamantinomatous craniopharyngiomas, Interferon-2α was the predominant targeted therapy (29%), whereas dabrafenib took precedence (70%) for papillary craniopharyngiomas. Treatment durations varied, ranging from 1.7 to 28 months. Positive responses, including CR or NCR, were observed in both types of craniopharyngiomas (29% CR for adamantinomatous; 32% CR for papillary). Adverse events, such as constitutional symptoms and skin changes, were reported, emphasizing the need for vigilant monitoring and personalized management to enhance treatment tolerability. Overall, the data highlighted a diverse landscape of targeted therapies with encouraging responses and manageable adverse events, underscoring the importance of ongoing research and individualized patient care in the exploration of treatment options for craniopharyngiomas. In the realm of targeted therapies for craniopharyngiomas, tocilizumab and dabrafenib emerged as prominent choices for adamantinomatous and papillary cases, respectively. While adverse events were common, their manageable nature underscored the importance of vigilant monitoring and personalized management. Acknowledging limitations, future research should prioritize larger, well-designed clinical trials and standardized treatment protocols to enhance our understanding of the impact of targeted therapies on craniopharyngioma patients.
摘要：
颅咽管瘤由于靠近关键的神经血管结构，在手术治疗中面临着独特的挑战。这项系统评价研究了遗传和免疫标记作为颅咽管瘤治疗的潜在目标。评估他们参与肿瘤发生，以及它们对预后和治疗策略的影响。系统审查遵循PRISMA准则，在PubMed上进行了彻底的文献检索，Ovid医疗系统,OvidEmbase.使用MeSH术语和布尔运算符，搜索的重点是颅咽管瘤,靶向或分子治疗，和临床结果或不良事件。纳入标准包括英语语言研究，临床试验（随机或非随机），并对金刚烷胺瘤或乳头状颅咽管瘤进行调查。靶向治疗,独立或联合化疗和/或放疗，检查是否包括临床结局或不良事件分析。主要结果通过随访MRI扫描评估疾病反应，将响应分类如下：完全响应(CR)，接近完全反应（NCR），部分响应,和基于病变消退百分比的稳定或进行性疾病。次要结果包括治疗类型和持续时间，以及不良事件。最初总共确定了891篇论文，其中2000年至2023年的26项研究最终被纳入审查。两张表突出显示了金刚烷虫瘤和乳头状颅咽管瘤，包括7和19项研究，分别。对于金刚瘤性颅咽管瘤，干扰素-2α是主要的靶向治疗（29%），而dabrafenib优先（70％）用于乳头状颅咽管瘤。治疗持续时间各不相同，从1.7到28个月不等。积极响应,包括CR或NCR，在两种类型的颅咽管瘤中都观察到（adamantinoma为29％CR；乳头状为32％CR）。不良事件,如体质症状和皮肤变化，据报道，强调需要警惕监测和个性化管理，以提高治疗耐受性。总的来说,这些数据突出了靶向治疗的不同景观，具有令人鼓舞的反应和可控的不良事件，强调在探索颅咽管瘤治疗方案时,持续研究和个体化患者护理的重要性.在颅咽管瘤的靶向治疗领域，tocilizumab和dabrafenib成为adamantinoma和乳头状病例的突出选择，分别。虽然不良事件很常见，它们的可管理性质强调了警惕监测和个性化管理的重要性。承认局限性，未来的研究应该优先考虑更大的，精心设计的临床试验和标准化治疗方案，以增强我们对靶向治疗对颅咽管瘤患者的影响的理解。
