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Published on: October 20, 2017
Postoperative surveillance of pediatric cerebellar pilocytic astrocytoma
Raphael Alford1, Lynn Gargan2, Daniel C Bowers3,4
1Department of Radiology, University of Texas Southwestern Medical Center, 1935 Medical District Drive, Dallas, TX, 75235, USA.
Insights
Pediatric cerebellar pilocytic astrocytomas (CPAs) rarely recur after gross total resection. Two negative MRI scans at least 3 months apart indicate no further follow-up is needed for these rare CPA recurrences.
Area of Science:
- Pediatric neuro-oncology
- Neuroimaging
- Oncology
Background:
- Cerebellar pilocytic astrocytomas (CPAs) are common pediatric brain tumors.
- Optimal follow-up imaging strategies after resection are not well-defined.
- Recurrence risk varies, necessitating evidence-based surveillance protocols.
Purpose of the Study:
- To determine the ideal frequency and duration of magnetic resonance imaging (MRI) follow-up for children with completely resected CPAs.
- To test the hypothesis that two negative MRIs, spaced at least 3 months apart, predict no further recurrence.
Main Methods:
- Retrospective review of 53 pediatric patients with CPAs from a Neuro-Oncology database (2000-2013).
- Exclusion of patients with brainstem involvement or neurofibromatosis type I.
- Analysis of MRI follow-up data, including tumor volumes and recurrence rates.
Main Results:
- A total of 53 patients were analyzed with a median follow-up of 6.05 years.
- Two consecutive negative MRIs over at least 3 months showed the lowest likelihood of recurrence (0.15).
- Only one recurrence (2.9%) was observed in 35 patients with gross total resection and >2 negative follow-ups, occurring 6.4 years post-resection.
Conclusions:
- Gross total resection of pediatric CPAs leads to a very low risk of late recurrence.
- Two consecutive negative MRI studies, separated by at least 3 months, are recommended to confirm remission.
- Frequent surveillance is advised until confirmed absence of tumor on serial imaging.
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.
