Cystic Craniopharyngiomas: Intratumoral Bleomycin Therapy

Abstract

The cystic nature of the majority of craniopharyngiomas has allowed consideration of intracystic therapies for these tumours, including instillation of beta-emitting radionuclides, bleomycin and more recently, alpha-interferon into the cyst. In this chapter, the focus is on the use of bleomycin. Intracystic bleomycin is delivered via an indwelling intracystic catheter attached to a subgaleal reservoir. The appropriate dosing of intracystic bleomycin has not been determined clearly. Intracystic bleomycin may be useful when an attempt at total resection is felt to be inappropriate or when delay of other treatment such as external radiotherapy is desirable. Intracystic chemotherapy may result in control of the cyst for a variable period of time and may allow significant delay of radiotherapy or radical resection, which can be particularly beneficial in the very young children. In the occasional case of what is felt to be an unresectable tumour, reduction of the cyst may change the assessment of the resectability of the tumor and allow an attempt at total resection. The complications of intracystic bleomycin are significant and more recently interferon alpha appears to be replacing bleomycin as the primary intracystic chemotherapeutic agent of choice for craniopharyngiomas.