Cerebellar astrocytoma of childhood: long-term follow-up

Abstract

Cerebellar astrocytoma of childhood has always been regarded as a benign tumour. Certain issues still attract debate, in particular the role of radiotherapy as an adjuvant to surgery, management of the cyst wall in cystic lesions and treatment of recurrent tumours. To provide some answers to these questions, the experience in Birmingham (United Kingdom) between the years 1959 and 1991 was reviewed. Ninety-seven patients aged 0-14 years had been treated and the histological material was reassessed independently. Detailed statistical and clinical analysis revealed that the main factor of negative prognostic value was the presence of brain stem involvement. In cystic tumours the surgical excision of the cyst wall did not offer significant advantage on survival. Similarly, postoperative radiotherapy did not improve survival, and there is a suggestion that it may actually predispose to malignant transformation. The implications on management are discussed.

Benign cerebellar pilocytic astrocytomas in children

“…We did not observe any improvement in prognosis after postoperative radiotherapy like Sgouros et al reported (20), but our number of patients was too small for statistical analysis. We prefer to perform second surgery for patients with residual tumor if it is possible because of the potential risks of radiotherapy.…”

“…Sgouros et al (20) reported that the outcome in cystic tumors is not so much different between total and subtotal resections. Pencalet et al (16) reported that they remove any macroscopically apparent abnormal cyst wall because of the risk of recurrence.…”

Malignant Brain Tumors in Childhood

“…Even in the setting of documented should residual, many tumors remain indolent. After imaging confirmed GTR, recurrence is uncommon, noted at 5% to 10% in major series (206,207,208). After incomplete resection, disease progression has been reported in 30% to 60% of cases at 5 years or more, long term survival remains above 65% (205,206,209).…”

“…Malignant gliomas are quite uncommon in the childhood cerebellum. The median age at diagnosis is 5 to 6 years, with 20% of cases younger than 3 years; astrocytomas of this location are rarely found in infants (206,207). Presenting symptoms often are confined to those associated with elevated intracranial pressure, with less frequent altered cerebellar function; cranial nerve deficits are uncommon.…”

“…The nodular or solid portion of the tumor characteristically enhances briskly; the cyst wall may or may not demonstrate contrast enhancement. The nodular and cystic components are considered part of the tumor; both components should be addressed at the time of S (206,207). Cerebellar JPAs have uncommonly been associated with multifocal CNS involvement, representing either neuraxis dissemination or concurrent multifocal presentation (208).…”