|
|
Surveillance
neuroimaging of intracranial medulloblastoma in children: how effective, how
often, and for how long?
Saunders DE, Hayward RD, Phipps KP, Chong WK, Wade AM
Department of Neuroradiology and Neurosurgery, Great Ormond
Street Hospital, London, United Kingdom.
SaundD@gosh.nhs.uk
Object. The goal of this paper was to review brain and spine images
obtained in children with medulloblastomas to determine the risk factors for
tumor recurrence and to assess the impact of surveillance imaging on patient
outcomes among patients who remain alive 1 month postsurgery.
Methods. Imaging studies and clinical data obtained in children
with medulloblastomas, who presented between January 1987 and August 1998, were
retrospectively reviewed.
Images were termed surveillance if they were follow-up studies and symptom
prompted if they were obtained to investigate new symptoms.
One hundred seven patients (mean age 6 years and 3 months, range 2 months-15
years and 6 months) were entered into the study.
Fifty-three children experienced tumor recurrence; 41 had one recurrence, nine
had two, and three had three recurrences.
Surveillance imaging revealed 10 of the first 53 recurrences and 15 of all 68
recurrences.
When the first recurrence was identified by the emergence of symptoms (42
patients), the children tended to survive for a shorter time (hazard ratio 3.72,
95% confidence interval 1.42-9.76, p = 0.008) than children in whom the first
recurrence was detected before symptoms occurred (10 patients).
The median survival time following symptomatic tumor recurrence was 4 months and
that after surveillance-detected tumor recurrence was 17 months.
The median increased survival time among patients whose recurrence was
asymptomatic and identified by imaging studies was 13 months, more than half the
mean time between surveillance imaging sessions.
Incomplete tumor resection was associated with a significantly reduced time to
recurrence (p = 0.048) and to death (p = 0.002).
The number of recurrences that were experienced was associated with a reduced
time to death (p < 0.001).
Conclusions. Surveillance imaging is associated with an increase
in survival in children with medulloblastomas.
More frequent surveillance imaging in children with incomplete tumor excision
and recurrent disease may further improve the length of survival.
PMID: 12924701 [PubMed - in process]
Source: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12924701&dopt=Abstract
|
