title: Role of radiotherapy in anaplastic ependymoma in children under age of 3 years: results of the prospective German brain tumor trials HIT-SKK 87 and 92.
abstract: OBJECTIVE
  To evaluate the outcome of very young children with anaplastic ependymoma after delayed or omitted radiotherapy (RT).
  
  
  METHODS
  Children under age of 3 years with anaplastic ependymoma were enrolled in the HIT-SKK 87 trial from 1987. After surgery, low-risk patients (R0, M0) received maintenance chemotherapy until elective RT at age of three. In high-risk patients (R+, M+) intensive induction chemotherapy was followed by maintenance chemotherapy and subsequently delayed RT. If there was, progression radiotherapy started immediately. In the HIT-SKK 92, trial MTX-based chemotherapy was applied. RT was administered in non-responders only.
  
  
  RESULTS
  Thirty-four children with anaplastic ependymoma were eligible (age 1.0-33.0 months). All children received chemotherapy. In 13 children, no RT was administered. Preventive RT after chemotherapy was given in nine, and salvage RT in 12 children. OS and PFS rates after 3-year were 55.9 and 27.3%, respectively. Twenty-five children relapsed. Positive impact on survival was observed in children with higher age, M0-stage, complete resection, and treatment with radiotherapy. Without RT only 3/13, children survived.
  
  
  CONCLUSIONS
  Delaying RT jeopardizes survival even after intensive chemotherapy. Predominant site of failure is the primary tumor site. RT of the neuraxis should be omitted in localized disease.
authors.affiliation: Department of Radiooncology, University of Tübingen, Tübingen, Germany. beate.timmermann@psi.ch
authors.forename: Beate
authors.initials: B
authors.lastname: Timmermann
authors.forename: Rolf-Dieter
authors.initials: RD
authors.lastname: Kortmann
authors.forename: Joachim
authors.initials: J
authors.lastname: Kühl
authors.forename: Stefan
authors.initials: S
authors.lastname: Rutkowski
authors.forename: Karin
authors.initials: K
authors.lastname: Dieckmann
authors.forename: Christof
authors.initials: C
authors.lastname: Meisner
authors.forename: Michael
authors.initials: M
authors.lastname: Bamberg
mesh_terms: D000367:Age Factors; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D002675:Child, Preschool; D004806:Ependymoma / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D011446:Prospective Studies; D012307:Risk Factors; D016879:Salvage Therapy; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D008727:Methotrexate