CRAN-22. IMPROVED ENDOCRINE OUTCOME WITH CONSERVATIVE SURGERY AND EARLY ADJUVANT RADIATION STRATEGY IN CHILDHOOD CRANIOPHARYNGIOMA: A REVIEW BY TREATMENT DECADE IN A SINGLE CENTRE

Neuroendocrine morbidity after Craniopharyngiomas may result from tumour position, recurrence/invasion and treatment. Over the last decades, our treatment policy has changed from aggressive tumour resection before 1995 to ‘hypothalamic-sparing’ surgery and, if required, early adjuvant radiation. We aimed to evaluate tumour recurrence and prevalence of endocrinopathy across treatment decades. 30 (22M) newly diagnosed children, median age 7.6(1.1–17.2)yrs (Group1), presenting between 2008–2015, underwent dynamic endocrine testing at diagnosis and were followed for 4.0(0.3–7.4)yrs. After urgent decompressive surgery if required, patients were conservatively managed in a neurooncology MDT setting with access to radiotherapy (either photon or proton therapy). Prevalence of Recurrence (PR) and endocrinopathy in Group1 were compared with those in our previous cohorts, [Group2a 1998–2010 (40 patients (18M) aged 8.6(7.2–10.0)yrs, followed for 6.0(4.8–7.2)yrs and Group3b 1973–1994 (75 patients (42M) aged 6.7(1–16.3)yrs, followed for 6.7(1.5–19.8)yrs], by chi-square statistics. PR of Group1(16.7%) and Group2(12.5%) was lower than Group3(41%, X2=5.8 and 10.1, p≤0.01). GHD was evident at diagnosis in 95% of Group1. Prevalence of post-treatment GHD and TSHD were similar across groups but life threatening ACTHD [Group1(56.7%) vs Group3(85.3%, X2=10.0, p≤0.01); Group2(72.5%), p=ns] and DI [Group1(56.7%) and Group2(55%) vs Group3(80%, X2=6.0 and 8.0, p≤0.01)], and Panhypopituitarism (Group1(56.7%) and Group2(50%) vs Group3(85.3%, X2=10.0 and 16.5, p≤0.01)] were lower in recent decades despite radiation. Dynamic testing at diagnosis confirms high rates (>95%) of occult pre-treatment GHD. A conservative surgical strategy protects against ACTHD, DI and Panhypopituitarism despite radiation, and similarly stabilises disease. aIkazoboh et al. SIOP 2011 abstract PM008 bDeVile et al. Arch Dis Child 75(2):108-114,1996