Monitoring For Glioma Recurrence: What To Know

When it comes to clinical monitoring, “We want to know if their neurologic function remains stable, if no new weakness, no new sensory loss, no new difficulty with thinking or information processing, new difficulties with walking develop. So we meet with patients, we examine them to establish that,” Dr. Nicolas Gonzalez Castro, a neuro-oncologist at the Dana-Farber Cancer Institute, tells SurvivorNet.

“… In addition to that, we try to get an idea of what’s going on in the brain. So we image it with MRI — often every two to three months early on when we’re still getting to know the behavior of the tumor, eventually we tend to separate the studies a little bit longer,” he explains.

What To Expect From Follow-Up Care

After treatment, your care team will see you regularly. As Dr. Castro mentions, these visits allow your doctor to check how you’re feeling, review any symptoms, and monitor for signs that the tumor may be changing. Advanced imaging — most commonly MRI scans and sometimes PET scans — is a key part of this process. These tools provide highly detailed pictures of the brain and help your team detect any abnormalities early.

Your follow-up schedule depends on the type of glioma you have, the treatment you received, and how stable your imaging has been. Early on, visits are usually more frequent, and they typically become less frequent as time goes on.

Brain MRIs are the main imaging study used in follow-up. During the first 1 to 2 years, MRIs are often done every 2-4 months depending on the aggressiveness of the tumor.

After several years of stability, the interval may be extended to every 6 months or even once a year, depending on your doctor’s recommendation.

Your doctor may adjust the schedule based on your individual situation, especially if you experience new symptoms or if the imaging shows anything unexpected.

When Would I Need A PET Scan?

FDG-PET (Fluorodeoxyglucose-PET) scans are not always required, but they can be helpful in certain situations.

“Tumors tend to either take up more glucose, more sugar as they need it for their metabolism, or they take up more of specific amino acids. So then we can put patients in a scanner and look if there’s more radioactive signal in one specific area,” Dr. Castro explains.

Your doctor may order a PET scan if:

• An MRI shows something unclear and they want additional information.
• There is concern that a spot on MRI may represent tumor regrowth rather than scar tissue or treatment-related changes.
• You are being evaluated for a clinical trial or a more advanced assessment.

Most patients with glioma do not need a PETCT.

Will I Ever Be Considered Cancer-Free?

This is a common and important question. Many gliomas — especially low-grade types — can remain stable for years or even decades. However, because gliomas can behave unpredictably, patients are generally described as being “in remission” or “stable” rather than “cured.”

That said, long periods of stability are absolutely possible, and many patients live full, active lives with no evidence of tumor progression.

What Happens If My Tumor Returns?

If imaging shows signs that the tumor has returned, your care team will talk with you right away about the next steps.

Options may include:

• Additional surgery
• Radiation therapy
• Chemotherapy or targeted treatments
• Enrollment in a clinical trial

The best approach depends on the tumor type, how long it has been stable, and your overall health. Importantly, many treatments can be effective even if the tumor comes back.

Questions To Ask Your Doctor

• What will my monitoring schedule look like after treatment?
• How frequently will I need to undergo MRI scans?
• What symptoms should I be on the look out for?
• What developments would indicate I need additional treatments?

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