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.