title: Combined postoperative irradiation and chemotherapy for anaplastic ependymomas in childhood: results of the German prospective trials HIT 88/89 and HIT 91.
abstract: OBJECTIVE
  To evaluate the outcome in children with anaplastic ependymomas after surgery, irradiation, and chemotherapy; and to identify prognostic factors for survival.
  
  
  METHODS
  Fifty-five children (n = 27 girls, 28 boys; median age at diagnosis, 6.2 years) with newly diagnosed anaplastic ependymomas were treated in the multicenter, prospective trials HIT 88/89 and HIT 91. Macroscopic complete resection was achieved in 28 patients; 27 patients underwent incomplete resection. All patients received chemotherapy before (n = 40) or after irradiation (n = 15). The irradiation volume encompassed either the neuraxis followed by a boost to the primary tumor site (n = 40) or the tumor region only (n = 13). No radiotherapy was administered in two patients.
  
  
  RESULTS
  Median follow-up was 38 months. The overall survival rate at 3 years after surgery was 75.6%. Disease progression occurred in 25 children with local progression occurring in 20. The median time to disease progression was 45 months. The only significant prognostic factor was the extent of resection (estimated progression-free survival [EPFS] after 3 years was 83.3% after complete resection and 38.5% after incomplete resection) and the presence of metastases at the time of diagnosis (0% vs. 65.8% 3-year EPFS in localized tumors). Age, sex, tumor site, mode of chemotherapy, and irradiation volume did not influence survival.
  
  
  CONCLUSIONS
  Treatment centers should be meticulous about surgery and diagnostic workup. Because the primary tumor region is the predominant site of failure it is important to intensify local treatment. Dose escalation by hyperfractionation or stereotactic radiotherapy might be a promising approach in macroscopically residual disease. The role of adjuvant chemotherapy requires further study.
authors.affiliation: Department of Radiooncology, University of Tübingen, Germany. betimmer@med.uni-tuebingen.de
authors.forename: B
authors.initials: B
authors.lastname: Timmermann
authors.forename: R D
authors.initials: RD
authors.lastname: Kortmann
authors.forename: J
authors.initials: J
authors.lastname: Kühl
authors.forename: C
authors.initials: C
authors.lastname: Meisner
authors.forename: I
authors.initials: I
authors.lastname: Slavc
authors.forename: T
authors.initials: T
authors.lastname: Pietsch
authors.forename: M
authors.initials: M
authors.lastname: Bamberg
mesh_terms: D000293:Adolescent; D001317:Austria; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D018450:Disease Progression; D018572:Disease-Free Survival; D004806:Ependymoma / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D005858:Germany; D006801:Humans; D015192:Infratentorial Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D008297:Male; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D015173:Supratentorial Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D015996:Survival Rate