SURVEILLANCE SCANNING OF CHILDREN WITH MEDULLOBLASTOMA

Background. The standard follow-up care for children with medulloblast oma includes regular clinical evaluations and surveillance scanning of the central nervous system with computed tomography or magnetic reson ance 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 periodi c history taking and physical examination with that of surveillance sc anning 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 1 980 and 1991. Recurrent tumors were classified as symptomatic if neuro imaging studies had been prompted by clinical symptoms or signs and as radiographic if the tumor had been detected by imaging in an asymptom atic patient. Results. Twenty-three of the 86 children (27 percent) ha d a recurrence of tumor. Four recurrences (17 percent) were detected o n scanning only, and 19 (83 percent) were associated with symptoms ari sing a median of four months after the previous scan. The median and r ange 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 refle cts the small number of patients and lead-time and length biases assoc iated 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 surviv ed.