title: Maximally safe resection followed by hypofractionated re-irradiation for locally recurrent ependymoma in children.
abstract: BACKGROUND
  Treatment failure in children with ependymoma is relatively common, with the majority of events consisting of local failure. Salvage therapy for these children historically had poor results, with repeated local recurrences. To improve these outcomes, we began to offer hypofractionated re-irradiation after resection at first local recurrence. To minimize the duration of therapy, we chose a hypofractionated regimen that has been shown to be well tolerated in adult patients.
  
  
  METHODS
  We performed a review of the experience at the Children's Hospital in Denver and at the Department of Radiation Oncology at the University of Colorado Denver from 1995 to 2008 with hypofractionated re-irradiation after maximally safe resection in children with locally recurrent ependymoma.
  
  
  RESULTS
  Six children with locally recurrent ependymoma were seen in that time period. After maximally safe resection, all six received hypofractionated radiation therapy of 24-30 Gy delivered in three fractions. With a median follow-up of 28 months from the time of re-irradiation, all six children are alive with no evidence of disease. Three children had evidence of radiation necrosis, either clinically or based on imaging, but none required significant intervention.
  
  
  CONCLUSIONS
  Hypofractionated re-irradiation after resection for locally recurrent ependymoma is well tolerated. This approach also appears to provide good local control. Additional follow-up is required to determine the efficacy and potential late effects of hypofractionated re-irradiation in this patient population.
authors.affiliation: Department of Radiation Oncology, University of Colorado Denver, Aurora, Colorado 80045, USA. arthur.liu@uchsc.edu
authors.forename: Arthur K
authors.initials: AK
authors.lastname: Liu
authors.forename: Nicholas K
authors.initials: NK
authors.lastname: Foreman
authors.forename: Laurie E
authors.initials: LE
authors.lastname: Gaspar
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Trinidad
authors.forename: Michael H
authors.initials: MH
authors.lastname: Handler
mesh_terms: D000293:Adolescent; D001932:Brain Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D004806:Ependymoma / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008499:Medical Records; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery*; D009367:Neoplasm Staging; D011379:Prognosis; D011879:Radiotherapy Dosage; D016879:Salvage Therapy; D016896:Treatment Outcome