The utility of routine surveillance screening with magnetic resonance imaging (MRI) to detect tumour recurrence in children with low-grade central nervous system (CNS) tumours: a systematic review

Abstract

BackgroundMagnetic resonance imaging (MRI) is routinely used as a surveillance tool to detect early asymptomatic tumour recurrence with a view to improving patient outcomes. This systematic review aimed to assess its utility in children with low-grade CNS tumours.MethodsUsing standard systematic review methods, twelve databases were searched up to January 2017.ResultsSeven retrospective case series studies (n = 370 patients) were included, with average follow-up ranging from 5.6 to 7 years. No randomised controlled trials (RCTs) were identified. Due to study heterogeneity only a descriptive synthesis could be undertaken. Imaging was most frequent in the first year post-surgery (with 2–4 scans) reducing to around half this frequency in year two and annually thereafter for the duration of follow-up. Diagnostic yield ranged from 0.25 to 2%. Recurrence rates ranged from 5 to 41%, with most recurrences asymptomatic (range 65–100%). Collectively, 56% of recurrences had occurred within the first year post-treatment (46% in the first 6-months), 68% by year two and 90% by year five. Following recurrence, 90% of patients underwent treatment changes, mainly repeat surgery (72%). Five-year OS ranged from 96 to 100%, while five-year recurrence-free survival ranged from 67 to 100%. None of the studies reported quality of life measures.ConclusionThis systematic review highlights the paucity of evidence currently available to assess the utility of MRI surveillance despite it being routine clinical practice and costly to patients, their families and healthcare systems. This needs to be evaluated within the context of an RCT.Electronic supplementary materialThe online version of this article (10.1007/s11060-018-2901-x) contains supplementary material, which is available to authorized users.

Surveillance imaging of grade 1 astrocytomas in children: can duration and frequency of follow-up imaging and the use of contrast agents be reduced?

“…Our results support previous published evidence demonstrating that completely resected cerebellar grade 1 astrocytomas rarely recur [2], with only one of 25 (4%) patients in our cohort recurring. For this group of patients in particular, we therefore suggest that a reduced frequency of surveillance imaging and a shorter overall surveillance period is likely to be adequate and to achieve a better balance for patients.…”

“…There is very limited data regarding the optimum surveillance imaging schedule in non-cerebellar tumours, as well as in tumours that are non-operatively managed or incompletely resected. Stevens et al highlight that 75% of the tumours in their systematic review of surveillance imaging were cerebellar and the majority completely resected (which is likely to explain why our recurrence/progression rate of 35% is higher than their reported overall rate of 24%) [2].…”

“…This is in addition to the cost of anxiety for the family surrounding every scan performed and the time and workload burden for clinicians. The evidence available in the literature to date is limited and does not convincingly support any particular surveillance strategy [2], and as such there is no consensus approach as to the frequency or duration of surveillance imaging, resulting in a lack of heterogeneous practice even within hospitals, let alone nations. This is not satisfactory patient care.…”

How to Teach English to Children Early on

“…Another effective strategy for kids to learn to speak English properly is to practice it often every day. Along with regular talks, you can set up a certain period of time each day for kids to practice their English (Stevens et al, 2018). Therefore, it is preferable if the English learning session is set up for a short period of time, such as 15 to 20 minutes because children have a tendency to get bored rapidly.…”

The utility of routine surveillance screening with magnetic resonance imaging to detect tumor recurrence/progression in children with high‐grade central nervous system tumors: a systematic review

“…The authors have also undertaken a systematic review on the effectiveness of surveillance MRI in pediatric low‐grade tumors, which forms a companion piece to this review paper …”