Medical Student University of Colorado Anschutz Medical Campus
Introduction: The management of recurrent Rathke cleft cyst (RCC) poses a unique clinical challenge. The mainstay of treatment is re-operation with cyst drainage, however, there is limited evidence evaluating adjuvant pharmaceutical therapy in this patient population. Several studies, including a 2018 paper by Ung et. al. at our institution, suggest a potential benefit of the use of intracystic bleomycin in recurrent RCC. The intracystic application of bleomycin is known to be beneficial in the treatment of cystic craniopharyngioma, however, its usefulness in the treatment of recurrent Rathke cleft cyst remains unknown. Here we evaluate long-term outcomes of recurrent RCC treated with intracystic bleomycin (up to 14 years), expanding on a 2018 paper by our institution which reported zero short-term follow-up recurrence.
Methods: We performed a retrospective chart review of patients with RCC who underwent surgical resection between January 2010 and December 2023 by a single surgeon. Specific attention was paid to patients with recurrent RCC and received intracystic bleomycin at reoperation. Patient symptom ratings, pre- and post-operative, were collected.
Results: Of the 68 patients operated on for RCC from January 2010 to December 2023, 23 experienced symptomatic recurrence (33.8%). Intracystic bleomycin was administered at reoperation in 21 of these patients. To date, only two patients who received intracystic bleomycin experienced recurrence (9.5%) with a mean follow-up of 35.9 ± 32.1 months.
Conclusion : The use of intracystic bleomycin may be a safe and potentially effective treatment option in patients with recurrent RCC. Additional studies where bleomycin is deployed as primary treatment for RCC will be useful in further evaluating efficacy of bleomycin as a primary treatment modality.
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