title: A retrospective study of surgery and reirradiation for recurrent ependymoma.
abstract: OBJECTIVE
  To report disease control for patients with recurrent ependymoma (EP) treated with surgery and a second course of radiation therapy (RT(2)).
  
  
  METHODS
  Thirty-eight pediatric patients (median age, 2.7 years) with initially localized EP at the time of definitive RT underwent a second course of RT after local (n = 21), metastatic (n = 13), or combined (n = 4) failure. Reirradiation included radiosurgery (n = 6), focal fractionated reirradiation (n = 13), or craniospinal irradiation (CSI; n = 19).
  
  
  RESULTS
  Initial time to failure was 16 months, and median age at second treatment was 4.8 years. Radiosurgery resulted in significant brainstem toxicity and one death (median dose, 18 Gy). Progression-free survival ratio was greater than unity for 4 of 6 patients; there was one long-term survivor. Three of 13 patients treated using focal fractionated reirradiation (median combined dose, 111.6 Gy) experienced metastasis. The CSI was administered to 12 patients with metastatic failure, 3 patients with local failure, and 4 patients with combined failure. The 4-year event-free survival rate was 53% +/- 20% for 12 patients with metastatic failure treated with CSI. Failure after CSI was observed in 1 of 3 patients with a history of local failure and 3 of 4 patients with a history of combined failure.
  
  
  CONCLUSIONS
  Patients with locally recurrent EP experience durable local tumor control, but remain at risk of metastasis. Patients with metastatic EP failure may receive salvage therapy that includes a component of CSI. Durability of disease control and long-term effects from this approach require further follow-up.
authors.affiliation: Department of Radiological Sciences, Division of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA. thomas.merchant@stjude.org
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Merchant
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Boop
authors.forename: Larry E
authors.initials: LE
authors.lastname: Kun
authors.forename: Robert A
authors.initials: RA
authors.lastname: Sanford
mesh_terms: D000293:Adolescent; D001932:Brain Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D016543:Central Nervous System Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D016371:Cranial Irradiation / Q000379:methods; D004806:Ependymoma / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D016634:Radiosurgery; D011879:Radiotherapy Dosage; D019233:Retreatment; D012189:Retrospective Studies; D013120:Spinal Cord Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery