Recurrence may take place in childhood cerebellar gliomas and may develop many years after initial treatment. Disease can be at the primary tumor site or, especially in malignant tumors, at noncontiguous central nervous system sites. Systemic relapse is rare, but may occur. At the time of recurrence, a complete evaluation to determine the extent of relapse is indicated for all patients. Biopsy or surgical resection may be necessary for confirmation of relapse because other entities such as secondary tumor and treatment-related brain necrosis may be clinically indistinguishable from tumor recurrence. The need for surgical intervention must be individualized on the basis of the initial tumor type, the length of time between initial treatment and the reappearance of the mass lesion, and the clinical picture.

Patients with cerebellar astrocytoma (pilocytic or diffuse) who relapse after being treated with surgery alone should be considered for another surgical resection.[1] If this is not feasible, local radiation therapy is the usual treatment.[2] If there is recurrence in an unresectable site after irradiation, chemotherapy should be considered.[2] There is little information regarding the activity of chemotherapy in this disease. Studies of novel therapeutic approaches that are designed to test the activity and toxicity of chemotherapy in recurrent brain tumor patients should be considered.

References

1. Austin EJ, Alvord EC Jr: Recurrences of cerebellar astrocytomas: a violation of Collins' law. J Neurosurg 68 (1): 41-7, 1988.  [PUBMED Abstract]
   
   
2. Garcia DM, Marks JE, Latifi HR, et al.: Childhood cerebellar astrocytomas: is there a role for postoperative irradiation? Int J Radiat Oncol Biol Phys 18 (4): 815-8, 1990.  [PUBMED Abstract]