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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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.


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.



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.