Central Nervous System Cancers
Anaplastic Glioma or Glioblastoma Multiforme
- Immediately post excision <72 hrs MRI
- Then once 2-6 weeks after RT
- Then every 2-3 months for 3 years
- Then annually
Astrocytoma or Oligodendroglioma (Low Grade)
Follow up after resection
- Initial post therapy MRI then
- MRI every 3-6 months for five years then annually
Adult Intracranial Ependymoma
- Post resection contrast enhanced MRI of Brain <72 hours after surgery, and contrast enhanced MRI of Spine (>2 weeks after surgery to avoid post surgical artifacts.)
MRI of the Brain (and MRI of the spine if initially positive)
- Every 3-4 months for 1 year
- Then every 4-6 months for year 2
- Then every 6 – 12 months
Adult Medulloblastoma and Supratentorial PNET (Primitive NeuroEctodermal Tumor)
- Post resection contrast enhanced MRI of Brain <72 hours after surgery, and contrast enhanced MRI of Spine (>2 weeks after surgery to avoid post surgical artifacts.)
Follow up
- Brain MRI every 3 months for 2 years, then every 6 months for 3 years, then annually
- Spine MRI every 6 months for 2 years, then annually for 3 years.
Primary Lymphoma of the CNS
Prior to treatment
- CT Chest, Abdomen and Pelvis OR PET/CT
- MRI of Spine if symptomatic or of CSF sampling was positive for lymphoma
Follow up
- Brain MRI: every 3 months for 2 years, then every 6 months for 3 years, and then annually for at least 5 years
Primary Spinal Cord Tumors
- Follow up MRI exams every 6 months for 2 years or if clinically indicated. (no reference available)
Meningioma
WHO grades 1 (benign meningioma) and 2 (atypical meningioma) or unresected
- MRI at 3, 6, then every 6 months for 5 years, then annually
- Who Grade 3 MRI every 3-6 months for 5 years, then annually for 5 years
Metastasis to the Spine
- Spinal MRI if there is severe rapidly increasing spine pain or Neurologic findings
Metastasis to the Brain on MRI exam
Limited to three or fewer lesions
Unknown Primary
- CT Chest, Abdomen and Pelvis, PET if nondiagnostic
- Then MRI of brain every 3 months for a year
- Then MRI of brain only for worsening clinical situation
Known Cancer elsewhere
- Then MRI of brain every 3 months for a year
- Then MRI of brain only for worsening clinical situation
More than three lesions on MRI
- Then MRI of brain every 3 months for a year
- Then MRI of brain only for worsening clinical situation
Metastasis to the Meninges suspected on clinical evaluation
- MRI brain and spine
- CSF Flow study (Nuclear or other) if intraventricular catheter is anticipated
References
- NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) Central Nervous System Cancers Version 1.2015 (Accessed May and June 2015)
- NCCN Clinical Practice Guidelines in Oncology Central Nervous System Cancers V.1.2008 accessed 1/20/09
- NCCN Clinical Practice Guidelines in Oncology Central Nervous System Cancers V.2.2012 accessed 5/18/2012 and 8/2/2012
- Cerebrospinal Fluid Spread of Anaplastic Glioma Ozden Narin, Jan Drappatz, Lisa M. Doherty, Patrick Y. Wen, and Santosh Kesari J. Clin. Oncol., Feb 2007; 25: 596 – 597.
- Prognostic significance of preoperative MRI scans in glioblastoma multiforme. Hammoud, Maarouf A., et al. Journal of neuro-oncology 27.1 (1996): 65-73.
- Aghi MK, Carter BS, Cosgrove GR, et al. Long-term recurrence rates of atypical meningiomas after gross total resection with or without postoperative adjuvant radiation. Neurosurgery 2009; 64:56.
- Multidisciplinary Management of Brain Metastases April F. Eichler, Jay S. Loeffler The Oncologist 2007; 12:884-898; doi:10.1634/theoncologist.12-7-884 (Accessed 6/10/15)
- Should patients with lymphangioleiomyomatosis undergo screening for meningioma? V. Cottin, S. Vukusic, E. Jouanneau, R. Lazor, and J-F. Cordier Eur. Respir. J., Nov 2004; 24: 888 – 889.
- Comparison of 68Ga-DOTATOC-PET/CT and PET/MRI hybrid systems in patients with cranial meningioma: Initial results Ali Afshar-Oromieh, Maya B. Wolf, et al Neuro Oncology, Feb 2015; 17: 312 – 319 (finds PET/MRI is “idea combination” available imaging procedure)