Management of Recurrent Central Neurocytoma

Initial Assessment and Staging

Obtain contrast-enhanced brain MRI to define the extent of recurrent disease and assess for any new areas of involvement, as recommended by the National Comprehensive Cancer Network 1
Consider CSF sampling if spinal imaging suggests dissemination or if multiple lesions are present, as suggested by the National Comprehensive Cancer Network 1
Multidisciplinary consultation involving neurosurgery, radiation oncology, and neuro-oncology is essential before finalizing treatment strategy, according to the National Comprehensive Cancer Network 1, 2

Doses of ≥12 Gy are recommended for optimal local tumor control rates exceeding 90% at 5 years, as reported in Neurosurgery 3
Consider repeat maximal safe resection if the tumor is causing mass effect, hydrocephalus, or progressive neurological symptoms, as recommended by the National Comprehensive Cancer Network 1, 2
Complete resection is associated with improved survival when achievable, according to the National Comprehensive Cancer Network 2

Temozolomide is another viable chemotherapy option that has been used successfully in the recurrent setting, as reported by the National Comprehensive Cancer Network 1

MR spectroscopy, MR perfusion, or PET imaging should be considered to differentiate true tumor recurrence from radiation necrosis or pseudoprogression, as recommended by the National Comprehensive Cancer Network 4

Brain MRI every 3 months for the first 2 years, then every 6 months for years 3-5, then annually, as suggested by the National Comprehensive Cancer Network 1
Spinal MRI should be performed if the patient had prior spinal involvement or develops new neurological symptoms, according to the National Comprehensive Cancer Network 1
CSF sampling should be repeated if new dissemination is suspected on imaging, as recommended by the National Comprehensive Cancer Network 1