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

Authors:
  • HEHans-Georg Eder
    Hans-Georg Eder
  • PSPetra Sovinz
    Petra Sovinz
  • JRJohann Raith
    Johann Raith
  • HLHerwig Lackner
    Herwig Lackner
  • AMAndrea Moser
    Andrea Moser
  • CUChristian Urban
    Christian Urban
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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 (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.

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