Intracranial ependymomas in children: society of pediatric oncology experience with postoperative hyperfractionated local radiotherapy.
OBJECTIVE
To prospectively investigate the role of local hyperfractionated radiotherapy (RT) after surgical resection in the treatment of intracranial ependymomas in children.


METHODS
Postoperative local hyperfractionated RT was proposed for every child (>5 years old at diagnosis) with localized intracranial ependymoma. The planned dose was 60 Gy after complete resection (CR) and 66 Gy after partial resection, delivered in two daily fractions of 1 Gy, according to the early postoperative imaging findings.


RESULTS
Between November 1996 and December 2002, 24 children with infratentorial (n = 20) or supratentorial (n = 4) intracranial ependymoma were included. The median age was 8.6 years (range, 5-17). The World Health Organization grade was anaplastic in 10 of the 24 patients (not assessable in 1). After a retrospective central review, a CR was reported in 16 patients, partial resection in 4, and doubtful resection in 4. The radiation dose was 60 Gy in 18 cases (one partial resection), 66 Gy in 5 cases (one CR), and 54 Gy in 1 case (CR). The 5-year overall survival rate was 74.8%, and the progression-free survival rate was 54.2%. Of the 24 patients, 11 developed a relapse: 7 local only and 4 metastatic and local. The histological grade and extent of resection were not prognostic factors. More than 3 in 4 children had no sequelae of RT at a median follow-up of 7 years (95% confidence interval, 66.4-90.0 months).


CONCLUSIONS
The results of our study have shown that hyperfractionated RT is safe but provides no outcome benefit compared with other strategies of RT such as standard fractionated regimens.
Department of Pediatrics, Centre Léon Bérard, Lyon, France. conter@lyon.fnclcc.fr
Cécile
C
Conter
Christian
C
Carrie
Valérie
V
Bernier
Anne
A
Geoffray
Anne
A
Pagnier
Jean-Claude
JC
Gentet
Arielle
A
Lellouch-Tubiana
Sylvie
S
Chabaud
Didier
D
Frappaz
D000293:Adolescent; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D019583:Dose Fractionation, Radiation; D004806:Ependymoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006309:Hearing / Q000528:radiation effects; D006801:Humans; D007360:Intelligence / Q000528:radiation effects; D008297:Male; D008495:Medical Oncology; D009364:Neoplasm Recurrence, Local; D011446:Prospective Studies; D011597:Psychomotor Performance / Q000528:radiation effects; D011878:Radiotherapy / Q000009:adverse effects; D012955:Societies, Medical; D015996:Survival Rate; D014785:Vision, Ocular / Q000528:radiation effects