Conflict of interest: Nothing to declare.
Marker (+) CNS germ cell tumors in remission: Are surveillance MRI scans necessary?
Article first published online: 3 DEC 2013
© 2013 Wiley Periodicals, Inc.
Pediatric Blood & Cancer
Volume 61, Issue 5, pages 853–854, May 2014
How to Cite
Martinez, S., Khakoo, Y., Gilheeney, S., Kramer, K., Wolden, S., Souweidane, M. and Dunkel, I. J. (2014), Marker (+) CNS germ cell tumors in remission: Are surveillance MRI scans necessary?. Pediatr. Blood Cancer, 61: 853–854. doi: 10.1002/pbc.24888
This work was presented at the 2012 15th International Symposium on Pediatric Neuro-oncology in Toronto, ON.
- Issue published online: 9 MAR 2014
- Article first published online: 3 DEC 2013
- Manuscript Accepted: 7 NOV 2013
- Manuscript Received: 5 JUL 2013
- Witmer fund (partial support)
- CNS tumors;
- germ cell tumors;
- tumor markers
Patients with marker (+) CNS germ cell tumors are usually followed with both surveillance MRI scans and serum tumor markers. We hypothesized that patients with elevated serum tumor markers at diagnosis who achieve a complete biochemical and radiological remission may not need surveillance MRI scans.
We retrospectively identified 31 patients with CNS germ cell tumors who presented with an elevated serum tumor marker at the time of diagnosis. We reviewed the records of those patients who (1) achieved a complete biochemical and radiological remission and (2) later suffered tumor recurrence to determine whether the recurrence was detectable biochemically, radiologically, or via both modalities.
Nine patients suffered tumor recurrence following initial remission. All 9 had elevated serum tumor markers at recurrence and 8 had MRI evidence of recurrence. The 1 patient with isolated biochemical evidence of recurrence developed MRI evidence of recurrence 15 months later without intervening treatment. One other patient (not one of the 9) had a secondary malignancy (anaplastic astrocytoma) identified by brain MRI scan.
Patients with CNS germ cell tumors who present with elevated serum tumor markers at diagnosis and achieve a complete biochemical and radiological remission may not need surveillance MRI scans to monitor for recurrence, but MRI scans may be considered to monitor for secondary malignancy. If other series replicate these findings, surveillance via monitoring of serum tumor markers only could be done and omission or reduction of the frequency of surveillance MRI scans could save a significant amount of money. Pediatr Blood Cancer 2014;61:853–854. © 2013 Wiley Periodicals, Inc.