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

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.

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.

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.

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.

• Authors: David Y Mak, Normand Laperriere, Vijay Ramaswamy, Eric Bouffet, Jeffrey C Murray, Rene Y McNall-Knapp, Kevin Bielamowicz, Arnold C Paulino, Wafik Zaky, Susan L McGovern, M Fatih Okcu, Uri Tabori, Doaa Atwi, Peter B Dirks, Michael D Taylor, Derek S Tsang, Abhishek Bavle
• Journal: Neuro-oncology advances (Neurooncol Adv) 2021 Jan-Dec Vol. 3 Issue 1 Pg. vdab158 ISSN: 2632-2498 [Electronic] England
• PMID: 34988448 (Publication Type: Journal Article)
• Copyright: © The Author(s) 2021. Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology.