Residual or Recurrent Cerebellar Low-Grade Glioma in Children after Tumor Resection: Is Re-Treatment Needed? A Single Center Experience from 1983 to 2003

Abstract

Purpose: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. Patients and 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.

Neurosurgical treatment of low-grade cerebellar astrocytoma in children and adolescents: a single consecutive institutional series of 100 patients

“…8 Several authors 2,20 have pointed to such spontaneous regression of residual tumor, and it is well known that incomplete resection may be sufficient to obtain long-term control of disease. 17 It is therefore our policy to wait for residual tumor growth before a second resection is considered, unless it is found on the immediate postoperative MR image and appears easily resectable.…”

Predictive factors for early symptomatic recurrence in pilocytic astrocytoma: Does angiogenesis have a role to play?

“…[1][2][3][4]6 Recurrence rates of 6-9% have been reported after gross total excision of the tumor, with most recurrences seen within 4-5 years of the primary surgery. 2,9,10 Several studies address the pattern of recurrences in PA and possible etiological factors. Krieger et al, in a series of 36 patients, reported recurrence in 12 patients of whom three (8.3%) had gross total excision of the tumor on immediate postoperative studies.…”

“…3,14 Benesch et al advocated a ''wait and watch'' policy for residual tumors with close radiological followup. 10 Although gross total excision of the tumor is associated with a lower likelihood of recurrence, incomplete excision is not always associated with symptomatic recurrence of disease and is not the sole prognostic factor for recurrence. 2,4,6,10,13,14 Postoperative radiotherapy has not proven to significantly reduce recurrence rates.…”

Pediatric Brain Tumors: Current Treatment Strategies and Future Therapeutic Approaches

“…Second-look surgery is a viable option in case of recurrence or progression. 99,101,102 Cerebellar astrocytomas, mainly consisting of grade I and II astrocytomas histologically, are curable by GTR. Recurrence-free survival is greater than 95% at 10 and 20 years.…”