Cerebellar astrocytoma of childhood : long-term follow-up

Cerebellar astrocytoma of childhood has always been regarded as a benign tumour. Certain issues still attract debate, in particular the role of radiotherapy as an adjuvant to surgery, management of the cyst wall in cystic lesions and treatment of recurrent tumours. To provide some answers to these questions, the experience in Birmingham (United Kingdom) between the years 1959 and 1991 was reviewed. Ninety-seven patients aged 0-14 years had been treated and the histological material was reassessed independently. Detailed statistical and clinical analysis revealed that the main factor of negative prognostic value was the presence of brain stem involvement. In cystic tumours the surgical excision of the cyst wall did not offer significant advantage on survival. Similarly, postoperative radiotherapy did not improve survival, and there is a suggestion that it may actually predispose to malignant transformation. The implications on management are discussed.