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Reevaluating surgery and re-irradiation for locally recurrent pediatric ependymoma-a multi-institutional study.

Authors :
Mak DY
Laperriere N
Ramaswamy V
Bouffet E
Murray JC
McNall-Knapp RY
Bielamowicz K
Paulino AC
Zaky W
McGovern SL
Okcu MF
Tabori U
Atwi D
Dirks PB
Taylor MD
Tsang DS
Bavle A
Source :
Neuro-oncology advances [Neurooncol Adv] 2021 Nov 08; Vol. 3 (1), pp. vdab158. Date of Electronic Publication: 2021 Nov 08 (Print Publication: 2021).
Publication Year :
2021

Abstract

Background: The goal of this study was to evaluate extent of surgical resection, and timing and volume of re-irradiation, on survival for children with locally recurrent ependymoma.<br />Methods: Children with locally recurrent ependymoma treated with a second course of fractionated radiotherapy (RT2) from 6 North American cancer centers were reviewed. The index time was from the start of RT2 unless otherwise stated.<br />Results: Thirty-five patients were included in the study. The median doses for first radiation (RT1) and RT2 were 55.8 and 54 Gy, respectively. Median follow-up time was 5.6 years. Median overall survival (OS) for all patients from RT2 was 65 months. Gross total resection (GTR) was performed in 46% and 66% of patients prior to RT1 and RT2, respectively. GTR prior to RT2 was independently associated with improved progression-free survival (PFS) for all patients (HR 0.41, P = 0.04), with an OS benefit (HR 0.26, P = 0.03) for infratentorial tumors. Median PFS was superior with craniospinal irradiation (CSI) RT2 (not reached) compared to focal RT2 (56.9 months; log-rank P = 0.03). All distant failures (except one) occurred after focal RT2. Local failures after focal RT2 were predominantly in patients with less than GTR pre-RT2.<br />Conclusions: Patients with locally recurrent pediatric ependymoma should be considered for re-treatment with repeat maximal safe resection (ideally GTR) and CSI re-irradiation, with careful discussion of the potential side effects of these treatments.<br /> (© The Author(s) 2021. Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology.)

Details

Language :
English
ISSN :
2632-2498
Volume :
3
Issue :
1
Database :
MEDLINE
Journal :
Neuro-oncology advances
Publication Type :
Academic Journal
Accession number :
34988448
Full Text :
https://doi.org/10.1093/noajnl/vdab158