Surveillance imaging strategies following surgery and/or radiotherapy for childhood cerebellar low-grade astrocytoma.
OBJECTIVE
The authors sought to evaluate surveillance strategies for the detection and monitoring of residual and recurrent disease in children with cerebellar low-grade astrocytomas (CLGAs) treated surgically or with radiotherapy. Patients were divided into three groups: (1) those in whom a "complete" resection was achieved; (2) those with residual disease with no immediate adjuvant therapy; and (3) those who received radiotherapy for residual/recurrent disease.


METHODS
Magnetic resonance (MR) imaging studies and clinical data obtained in children with CLGA who presented between January 1988 and September 1998 were reviewed. Eighty-four children were followed for a mean period of 73 months (range 2-159 months). One child died. Of the 70 children in whom a complete resection was achieved, nine (13%) developed a recurrence detected by surveillance imaging at 6, 8, 9, 9, 13, 27, 39, 44, and 47 months, respectively. Following an incomplete resection, radiologically detected tumor progression leading to further treatment was detected at 7, 9, 12, 13, and 20 months, respectively, and an additional six tumors regressed or stablized. In 11 of 12 children treated with radiotherapy, stabilization/regression occurred radiologically at a mean of 14.9 months.


CONCLUSIONS
The authors recommend surveillance MR imaging in children treated for CLGA at 6 months and 1, 2, 3.5, and 5 years following a complete resection and after radiotherapy performed either initially or following recurrence. For follow up of residual tumor, 6-month interval imaging for at least 3 years, yearly images for another 2 years, and subsequent 2-year imaging is recommended.
Saunders
Dawn E
DE
Department of Neuroradiology, Great Ormond Street Hospital, London, United Kingdom. SaundD@gosh.nhs.uk
Phipps
Kim P
KP
Wade
Angela M
AM
Hayward
Richard D
RD
D000293:Adolescent; D001254:Astrocytoma / Q000175:diagnosis* / Q000532:radiotherapy / Q000601:surgery; D002528:Cerebellar Neoplasms / Q000175:diagnosis* / Q000532:radiotherapy / Q000601:surgery; D002531:Cerebellum / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D011182:Postoperative Care; D012075:Remission, Spontaneous; D013997:Time Factors; D014057:Tomography, X-Ray Computed