Residual or recurrent cerebellar low-grade glioma in children after tumor resection: is re-treatment needed? A single center experience from 1983 to 2003.
OBJECTIVE
The aim of this study was to report on children with cerebellar low-grade glioma (LGG), who were found to have progressive or nonprogresssive residual tumors or tumor recurrence after tumor resection.


METHODS
Medical records and magnetic resonance imaging (MRI) studies of children (<16 years) with cerebellar LGG were retrospectively analyzed.


RESULTS
Of 289 patients with CNS tumors referred between 1983 and 2003, 28 (9.7%) (15 male, 13 female; median age at diagnosis: 71 months) had cerebellar LGG (pilocytic astrocytoma grade I: n = 21; fibrillary astrocytoma grade II: n = 5; mixed hamartoma/pilocytic astrocytoma: n = 1; radiographic diagnosis: n = 1). Total resection was initially performed in 16 patients (57.1%), near total resection in 4 (14.3%), and partial resection in 6 patients (21.4%). One patient underwent biopsy. At a median follow-up of 112 months, 25 patients (89.3%) were alive, 18 of them being in complete remission. Three patients died, 2 due to symptoms related to brain stem compression/infiltration and 1 patient due to postoperative cerebral edema. Presently 5 patients have nonprogressive residual tumors and 2 patients developed nonprogressive recurrences 10 years and 20 months after initial total resection, respectively. None of them required second surgery and none received additional nonsurgical therapies. Only 1 additional patient had to undergo second surgery due to disease progression.


CONCLUSIONS
A 'wait and see' strategy is justified in patients with nonprogressive recurrent or residual cerebellar LGG after primary tumor resection. However, long-term follow-up with repeated MRI is mandatory in these patients to detect disease progression. Second surgery is indicated only in patients with unequivocal disease progression, as documented by MRI.
Benesch
Martin
M
Division of Pediatric Hematology and Oncology, Department of Pediatrics, Medical University of Graz, Graz, Austria. martin.benesch@klinikum-graz.at
Eder
Hans-Georg
HG
Sovinz
Petra
P
Raith
Johann
J
Lackner
Herwig
H
Moser
Andrea
A
Urban
Christian
C
D000293:Adolescent; D001254:Astrocytoma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D002528:Cerebellar Neoplasms / Q000175:diagnosis / Q000401:mortality / 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 / Q000175:diagnosis / Q000601:surgery*; D018365:Neoplasm, Residual / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate