Childhood cerebellar astrocytomas: is there a role for postoperative irradiation?

Eighty children with astrocytomas of the cerebellum were treated at Washington University Medical Center in St. Louis, Missouri from 1928-1980. The most important predictor of recurrence was completeness of surgical removal. Of 40 patients whose tumors were totally removed, only one recurred (2.5%). Forty cases were subtotally removed and 14 subsequently recurred (35%). Postoperative irradiation did not significantly improve survival in the patients with incompletely excised tumors; however, there was lack of uniformity in the radiation therapy. Although a survival advantage could not be demonstrated, there was a trend toward a lowering of the recurrence rates in patients with subtotally excised solid tumors who received radiation therapy.

Regional cerebral blood flow and oxygen utilization in superficial temporal-middle cerebral artery anastomosis patients: an exploratory definition of clinical problems.

Regional cerebral blood flow (rCBF) and regional cerebral oxygen utilization (rCMRO2) were measured before and after surgery in nine patients undergoing a superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis to bypass cerebrovascular lesions not amenable to extracranial operative procedures. The objective of these studies was to determine whether measurements of this type could provide objective criteria for surgery as well as assess the effect of surgery. The preliminary data, although limited, suggest that measurements of regional cerebral hemodynamics and metabolism in these patients before and after surgery provide valuable data upon which to develop criteria and assess results. For example, 1) a significant depression of rCBF and rCMRO2 in patients in whom a major cerebral infarction has not occurred, or 2) relative preservation of rCMRO2 despite depressed rCBF seem to be favorable indications for establishing a functioning STA-MCA anastomosis. In such patients, STA-MCA anastomosis can be followed by a return of rCBJ and rCMRO2 to virtually normal levels. Relatively normal rCBF and rCMRO2 in the presence of an occluded internal carotid artery in asymptomatic patients indicates satisfactory collateral circulation and is probably a contraindication to surgery.

Positron Emission Tomography (PET) with 1-Aminocyclobutane-1-[(11)C]carboxylic Acid (1-[(11)C]-ACBC) for Detecting Recurrent Brain Tumors.

This study was done to determine whether 1-[(11)C]ACBC PET has any advantages over 2-[(18)F]FDG PET, CT, or MRI in detecting recurrent brain tumors, and whether quantitative 1-[(11)C]ACBC PET information improves the accuracy of "visual" image interpretation.Twenty patients with recurrent brain tumor underwent dynamic PET. Images were analyzed by visual interpretation; in addition, standardized uptake values (SUVs) and Patlak values (k(1)*k(3)/k) were evaluated.1-[(11)C]ACBC identified 19/20 recurrent brain tumors, [18F]FDG 13/19, MRI 13/19, and CT 8/16. Based on SUVs, the average tumor-to-contralateral gray matter ratio of 1-[(11)C]ACBC was 5.0 and 0.5 for 2-[(18)F]FDG. Mean Patlak values of 1-[(11)C]ACBC were 0.044 +/- 0.047 for high and 0.034 +/- 0.026 for low grade tumors. However, visual interpretation was effective without quantitative PET data.1-[(11)C]ACBC, accurately detects recurrent tumors for selecting biopsy sites and treatment planning.