Pediatric Astrocytoma Follow-up

Updated: Sep 21, 2021
  • Author: Lauren R Weintraub, MD; Chief Editor: Max J Coppes, MD, PhD, MBA  more...
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Follow-up

Further Outpatient Care

Further outpatient care includes the following:

  • Chemotherapy: Chemotherapy for low-grade astrocytomas is currently administered in an outpatient setting for approximately 1 year.

  • Radiotherapy: Begin daily outpatient local radiotherapy after recovery from surgery for a high-grade astrocytoma or early recurrent and/or progressive low-grade astrocytoma. This is generally administered over 6 weeks (usual dose is 160-180 Gy/d).

  • Physical and neurologic examination

    • For resected low-grade astrocytomas, outpatient examinations every 1-3 months are sufficient.

    • For patients requiring radiotherapy, perform weekly monitoring of clinical response and potential treatment-related adverse effects during radiotherapy and then every 1-3 months thereafter for at least 1 year.

    • Protocols using investigational chemotherapy in place of, or following, radiotherapy dictate how frequently these examinations are conducted.

    • After 12-18 months from completion of therapy, these examinations are generally reduced to every 6 months for the next 2 years and annually thereafter, provided no interim complications occur.

    • Routinely perform baseline neuropsychology and developmental testing at the completion of therapy and annually thereafter.

  • Imaging studies

    • Postoperative MRI evaluation must be performed within 72 hours of surgery in order to delineate residual tumor from the postsurgical inflammatory changes that are visualized on MRI at this time.

    • MRI with contrast of the head should be performed every 3 months for the first 12-18 months after surgery and 4-6 weeks following the completion of radiotherapy. Subsequent imaging may be performed in conjunction with the physical and neurologic examination schedule, unless clinically indicated sooner. If a child is treated on an investigational clinical trial regimen, the protocol dictates the frequency of the imaging studies required.

    • Perform MRI of the spine annually in those patients with high-grade tumors unless evidence of leptomeningeal spread is noted at diagnosis, in which case the frequency of such examination is increased in accordance with the response to treatment.

  • Laboratory studies

    • Weekly CBC counts and annual neuroendocrine studies (eg, thyroid function tests, growth hormone, luteinizing hormone [LH]/follicle-stimulating hormone [FSH], estradiol) are all that is required during radiotherapy unless otherwise dictated by investigational regimens or if clinically indicated.

    • The CBC count is used to monitor hematopoietic toxicity and determine whether intervention should be carried out to maintain hemoglobin levels at or above 10 g/dL in order to maximize radiation efficacy.

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Inpatient and Outpatient Medications

Dexamethasone and antiseizure medications may be necessary to reduce the respective inflammatory response (edema) and seizure activity associated with the tumor and/or therapy.

Investigational protocols may dictate other medications, including chemotherapy.

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Transfer

Transfer patient to a pediatric center that can provide appropriate MRI imaging studies; pediatric neurosurgery; and pediatric hematology, oncology, or neuro-oncology. Pediatric radiation oncology and neurology may also be necessary for treatment and follow-up.

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