Purpose

To develop postoperative surveillance protocols that yield efficient detection rates of tumor recurrence or progression using fewer imaging studies and less cost.

Method

This is a retrospective cohort study of all pediatric craniopharyngioma patients who have been diagnosed and treated at Boston Children’s Hospital (BCH) between 1990 and 2017. All statistical analyses were performed using Stata.

Results

Eighty patients (43 males and 37 females) fulfilled the inclusion criteria. The mean age at time of diagnosis was 8.6 ± 4.4 years. The mean follow-up period was 10.9 ± 6.5 years. Overall 30/80 (37.5%) patients experienced tumor recurrence/progression. The median latency to recurrence/progression was 12.75 months (range 3 to 108 months), with 76.6% of the recurrences/progressions taking place within the first 2 years postoperatively. Given the lack of any clinical symptoms/signs associated with the vast majority of the recurrent/progressed cases, we propose postoperative MR imaging surveillance protocols that are substantially less intensive than the current practice. Therefore, we recommend the following postoperative MR imaging surveillance protocols, stratified by management strategies; 0, 9, 15, 36, 48, and 60 months for patients who underwent GTR, 0, 3, 6,12, 18, and 24 months for patients who underwent STR alone and 0, 3, 12, 72, 96, and 120 months for patients who underwent STR followed by subsequent XRT.

Conclusion

The proposed postoperative MR imaging surveillance protocols would provide a potential 50% decrement of healthcare costs. It may also minify the psychological burden of frequent MR scanning for these patients and their families.

中文翻译：

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小儿颅咽管瘤的术后MR成像监视：新的机构指南

目的

利用更少的影像学研究和更少的成本，开发出能够有效检测出肿瘤复发或进展率的术后监测方案。

方法

这是一项回顾性队列研究，研究对象是1990年至2017年之间在波士顿儿童医院（BCH）诊断和治疗的所有小儿颅咽管瘤患者。所有统计分析均使用Stata进行。

结果

八十例患者（男43例，女37例）符合纳入标准。诊断时的平均年龄为8.6±4.4岁。平均随访期为10.9±6.5年。总的30/80（37.5％）患者经历了肿瘤复发/进展。复发/进展的中位潜伏期为12.75个月（范围3至108个月），其中76.6％的复发/进展发生在术后头2年内。鉴于与大多数复发/进展中的病例无关的任何临床症状/体征，我们提出了术后MR成像监视方案，其强度明显低于当前实践。因此，我们建议按照管理策略对以下术后MR成像监视方案进行分层；0、9、15、36、48，

结论

拟议的术后MR成像监视方案将使医疗成本降低50％。这也可以减轻这些患者及其家人频繁进行MR扫描的心理负担。