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Previous Volume 330:892-895 March 31, 1994 Number 13 Next

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ABSTRACT

Background The standard follow-up care for children with medulloblastoma includes regular clinical evaluations and surveillance scanning of the central nervous system with computed tomography or magnetic resonance imaging. The evaluations and scanning assess the response of the tumor to treatment, detect any recurrence of disease, and monitor any complications of treatment. We compared the effectiveness of a periodic history taking and physical examination with that of surveillance scanning in detecting recurrent tumors.

Methods We reviewed the medical records, including 794 scanning reports or scans, of 86 children with posterior fossa medulloblastoma who were followed regularly between 1980 and 1991. Recurrent tumors were classified as symptomatic if neuroimaging studies had been prompted by clinical symptoms or signs and as radiographic if the tumor had been detected by imaging in an asymptomatic patient.

Results Twenty-three of the 86 children (27 percent) had a recurrence of tumor. Four recurrences (17 percent) were detected on scanning only, and 19 (83 percent) were associated with symptoms arising a median of four months after the previous scan. The median and range of survival after a recurrence of the tumor were 5 months and <1 to 38 months, respectively, for a symptomatic recurrence and 20 months and 10 to 32 months, respectively, for a radiographic recurrence (P = 0.03). No patient survived after a recurrence. The longer survival of patients with recurrent tumors detected by scanning most likely reflects the small number of patients and lead-time and length biases associated with screening.

Conclusions Among children with medulloblastoma, surveillance scanning is of little clinical value. Scanning detected a minority of recurrences, and no patient who had a recurrence survived.

Source Information

From the Departments of Neurology (C.F.T., S.R., P.C.P.), Neurosurgery (L.N.S.), Radiology (L.T.B., R.A.Z.), and Pediatrics (B.J.L.), Children's Hospital of Philadelphia; the Leonard Davis Institute of Health Economics and Department of Pediatrics (J.H.S.); and the Department of Radiation Therapy, Hospital of the University of Pennsylvania (J.W.G.) -- all at the University of Pennsylvania School of Medicine, Philadelphia.

Address reprint requests to Dr. Lange at the Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA 19104.

Full Text of this Article

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