title: Influence of radiotherapy treatment concept on the outcome of patients with localized ependymomas.
abstract: OBJECTIVE
  To assess the outcome of 57 patients with localized ependymomas treated with radiotherapy (RT).
  
  
  METHODS
  Fifty-seven patients with localized ependymomas were treated with RT. Histology was myxopapillary ependymoma (n = 4), ependymoma (n = 23), and anaplastic ependymoma (n = 30). In 16 patients, irradiation of the craniospinal axis (CSI) was performed with a median dose of 20 Gy. Forty-one patients were treated with local RT, with a local dose of 45 Gy to the posterior fossa, including a boost to the tumor bed of 9 Gy. In 19 patients, the tumor bed was irradiated with a median dose of 54 Gy.
  
  
  RESULTS
  Overall survival after primary diagnosis was 83% and 71% at 3 and 5 years. Five-year overall survival was 80% in low-grade and 79% in high-grade tumors. Survival from RT was 79% at 3 and 64% at 5 years. We could not show a significant difference in overall survival between CSI and local RT only. Freedom of local failure was 67% at 5 years in patients treated with CSI and 60% at 5 years after local RT. A rate of 83% for distant failure-free survival could be observed in the CSI group as opposed to 93% in the group receiving local RT only.
  
  
  CONCLUSIONS
  Local RT in patients with localized tumors is equieffective to CSI. The radiation oncologist must keep in mind that patients with localized ependymomas benefit from local doses > or =45 Gy.
authors.affiliation: Neuro-Radiation Oncology Research Group, Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany. Stephanie.Combs@med.uni-heidelberg.de
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Combs
authors.forename: Verena
authors.initials: V
authors.lastname: Kelter
authors.forename: Thomas
authors.initials: T
authors.lastname: Welzel
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Behnisch
authors.forename: Andreas E
authors.initials: AE
authors.lastname: Kulozik
authors.forename: Marc
authors.initials: M
authors.lastname: Bischof
authors.forename: Holger
authors.initials: H
authors.lastname: Hof
authors.forename: Jürgen
authors.initials: J
authors.lastname: Debus
authors.forename: Daniela
authors.initials: D
authors.lastname: Schulz-Ertner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D004307:Dose-Response Relationship, Radiation; D004806:Ependymoma / Q000401:mortality* / Q000532:radiotherapy*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011877:Radionuclide Imaging; D011878:Radiotherapy / Q000401:mortality*; D011879:Radiotherapy Dosage; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome