title: Evolution of neurological impairment in pediatric infratentorial ependymoma patients.
abstract: BACKGROUND
  Infratentorial ependymoma is a common central nervous system tumor of childhood and in patients >1 year of age is treated with maximally feasible surgical resection and radiotherapy. Because of this tumor typically arises within the 4th ventricle and can invade the brainstem, patients are at risk for significant neurological impairment.
  
  
  OBJECTIVE
  To characterize the incidence, evolution, and persistence of neurologic impairment in children with infratentorial ependymoma following maximal safe surgery and conformal or intensity-modulated radiation therapy (CRT/IMRT).
  
  
  METHODS
  After surgical resection, 96 children with non-metastatic infratentorial ependymoma were enrolled on a phase II study of image-guided radiation therapy and were prospectively followed with interval comprehensive neurological examinations. Late adverse neurological severity was graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE), version 3.0.
  
  
  RESULTS
  The most common deficits detected at baseline examination were limb dysmetria, cranial nerve VI/VII palsy, limb paresis, dysphagia, and truncal ataxia/hypotonia. When present, gait dysfunction and dysphagia were often severe. Oculomotor dysfunction, facial paresis, dysphagia, and gait impairment improved over time. With the exception of hearing loss, in the survivor cohort, very few severe late effects (CTCAE Grade 3/4/5) were present at 60 months survival.
  
  
  CONCLUSIONS
  In general, neurological deficits were maximal in the post-operative period and either remained stable or improved during radiation and the post-treatment evaluation period. With the exception of hearing, the majority of chronic residual neurological deficits in this at-risk population are mild and only minimally intrude upon daily life.
authors.affiliation: Division of Neurology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA. Brannon.morris@stjude.org
authors.forename: E Brannon
authors.initials: EB
authors.lastname: Morris
authors.forename: Chenghong
authors.initials: C
authors.lastname: Li
authors.forename: Raja B
authors.initials: RB
authors.lastname: Khan
authors.forename: Robert A
authors.initials: RA
authors.lastname: Sanford
authors.forename: Frederick
authors.initials: F
authors.lastname: Boop
authors.forename: Renee
authors.initials: R
authors.lastname: Pinlac
authors.forename: Xiaoping
authors.initials: X
authors.lastname: Xiong
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Merchant