Evidence-based recommendation for subsequent CNS neoplasms (IGHGa)

This page is part of the PanCare follow-up recommendations for surveillance of late effects. Click here, for more information on these recommendations.

Who is at risk for subsequent CNS neoplasms?

CAYA cancer survivors treated with

  • radiotherapy to a volume exposing the head or brain, including TBI

What subsequent CNS neoplasms might occur?

  • Meningiomas
  • (High-grade) gliomas
  • Other CNS neoplasms b

What surveillance modality should be used and at what frequency should it be performed?

  • Inform the survivor about symptoms and signs c that may be related to a subsequent CNS neoplasm
  • Neurologic history focused on symptoms c that may be related to subsequent CNS neoplasms
  • Neurologic examination focused on signs c that may be related to subsequent CNS neoplasms
    at every long-term follow-up evaluation, which may be at 1 – 5 year intervals
  • No recommendation can be formulated for routine MRI surveillance for asymptomatic survivors d

What should be done if abnormalities are identified?

  • Refer to the appropriate HCP


While PanCare strives to provide accurate and complete information that is up-to-date as of the date of publication, we acknowledge that the sequence of referral and diagnostic tests might vary according to the local and national healthcare system logistics.

It is recognised that survivors and their healthcare professionals have the final responsibility for making decisions concerning their long-term follow-up care. As such, they may choose to either adopt these recommendations or not to do so after individual informed discussion. It is good practice to document this decision.

In addition to regular surveillance, real-time awareness and prompt reporting of new symptoms and signs is essential to the early detection and timely treatment of late effects.

No warranty or representation, expressed or implied, is made concerning the accuracy, reliability, completeness, relevance, or timeliness of this information.

The PanCare materials are free to use for anyone aiming to inform about late effects and long-term survivorship care. However, no financial advantage may be achieved. All communication should reference PanCare and link to the PanCare website.

a This recommendation reflects the recommendations of the preliminary evidence-based IGHG subsequent CNS neoplasm guideline. The guideline will be published in a peer-reviewed journal soon.

b Pituitary tumors, neurilemmoma/schwannoma, opticus glioma, craniopharyngioma, medulloblastoma, pineal tumors, pilocytic astrocytoma, choroid plexus tumors, ependymoma, supratentorial tumor, oligodendroglioma, ganglioglioma

c Progressively worsening, severe, unrelenting headaches, new onset cognitive, motor, sensory or behavioral changes, balance problems, seizures, and other neurologic deficits

d There is currently insufficient evidence to determine whether early detection of subsequent CNS neoplasms reduces morbidity and mortality. The decision to undertake MRI surveillance should be made by the CAYA cancer survivor and healthcare provider after careful consideration of the potential harms and benefits of MRI surveillance (see Survivor Information Form).