title: Postoperative surveillance of pediatric cerebellar pilocytic astrocytoma.
abstract: The purpose of this study was to identify the optimal frequency and duration of magnetic resonance imaging follow-up in children who had gross totally resected cerebellar pilocytic astrocytomas (CPAs). Our hypothesis was that following two MR examinations, separated by at least 3 months, showing no evidence of tumor, gross totally resected CPAs did not recur and no further imaging follow-up was necessary. Retrospective review of Neuro-Oncology database from 1/2000 to 7/2013 yielded 53 patients with CPAs that had preoperative imaging and >2 years post-operative imaging follow-up available. Pilocytic astrocytomas with brainstem involvement and patients with neurofibromatosis type I were excluded. Preoperative tumor volumes were calculated. The dates and reports of the examinations were tabulated. The median number of follow-up examinations was 9 over a median follow-up time of 6.05 years (2.07-12.28 years). Two consecutive MR examinations over at least a 3 month span demonstrated the smallest negative likelihood ratio of future recurrence (0.15). There was no association of recurrence with preoperative tumor volume. Among the 35 patients with gross total resection of their tumor and greater than two negative follow-up examinations, one recurrence (2.9 %) was identified, occurring 6.4 years after initial resection. Gross totally resected pediatric CPAs can recur, but this is exceedingly rare. Frequent surveillance (every 3-6 months) is suggested in patients with CPAs until absence of tumor is concluded on imaging and documented on two consecutive studies spaced at least 3 months apart. The likelihood of recurrence thereafter is low.
authors: Department of Radiology, University of Texas Southwestern Medical Center, 1935 Medical District Drive, Dallas, TX, 75235, USA.
authors: Raphael
authors: R
authors: Alford
authors: Department of Neuro-Oncology, Children's Health, Dallas, TX, 75235, USA.
authors: Lynn
authors: L
authors: Gargan
authors: Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, 75235, USA.|Department of Pediatrics, Children's Health, Dallas, TX, 75235, USA.
authors: Daniel C
authors: DC
authors: Bowers
authors: Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, 75235, USA.|Department of Pediatrics, Children's Health, Dallas, TX, 75235, USA.
authors: Laura J
authors: LJ
authors: Klesse
authors: Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, 75235, USA.|Department of Neurosurgery, Children's Health, Dallas, TX, 75235, USA.
authors: Bradley
authors: B
authors: Weprin
authors: Department of Radiology, University of Texas Southwestern Medical Center, 1935 Medical District Drive, Dallas, TX, 75235, USA. korgun.koral@utsouthwestern.edu.|Department of Radiology, Children's Health, Dallas, TX, 75235, USA. korgun.koral@utsouthwestern.edu.
authors: Korgun
authors: 0000-0002-8695-300X
authors: K
authors: Koral
mesh_terms: D000293:Adolescent; D001254:Astrocytoma / Q000473:pathology* / Q000601:surgery*; D002528:Cerebellar Neoplasms / Q000473:pathology* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D012189:Retrospective Studies
keywords: Cerebellar; Children; Magnetic resonance imaging; Pilocytic astrocytoma; Surveillance