title: Post-operative radiation improves survival in children younger than 3 years with intracranial ependymoma.
abstract: Concerns regarding long-term toxicities have led to the avoidance of post-operative radiation (PORT) in young children with intracranial ependymoma. We investigated the association between post-operative radiation therapy and overall survival (OS) in children younger than 3 years and compared their survival to other age groups. The study sample from the SEER database included 804 patients with intracranial ependymoma, grades 2-3, and diagnosed between 1988 and 2005. OS was estimated using the Kaplan-Meier method, and hazard ratios (HR) and 95% confidence limits (CL) were calculated based on multivariable Cox proportional hazards models. A total of 804 patients were selected and PORT was administered to 35% of patients younger than 3 years. With a median follow-up of 3 years (range 0.1-18 years), the 3 year OS was 61% for children younger than 3 years, 83% for those ages 3-20 years, and 69% for patients older than 20 years (P < 0.001). In multivariable analysis, OS was significantly improved for patients receiving PORT (HR 0.8, 95% CL 0.6-0.9), and gross total resection (HR 0.6, 95% CL 0.5-0.8). Among children younger than 3 years, the 3 year OS was significantly greater among those who received PORT compared to those who did not (81% vs. 56%, respectively, P = 0.005). The majority of children younger than 3 years with intracranial ependymoma did not receive PORT. Children younger than 3 years who did not receive PORT had a relatively poor outcome, while those who received radiation therapy had a survival similar to older patients.
authors.affiliation: Department of Radiation and Cellular Oncology, The University of Chicago, 5758 South Maryland Avenue, M/C 9006, Chicago, IL 60637, USA. mkoshy@radonc.uchicago.edu
authors.forename: Matthew
authors.initials: M
authors.lastname: Koshy
authors.forename: Shayna
authors.initials: S
authors.lastname: Rich
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Merchant
authors.forename: Usama
authors.initials: U
authors.lastname: Mahmood
authors.forename: William F
authors.initials: WF
authors.lastname: Regine
authors.forename: Young
authors.initials: Y
authors.lastname: Kwok
mesh_terms: D000293:Adolescent; D001932:Brain Neoplasms / Q000401:mortality* / Q000532:radiotherapy* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D004806:Ependymoma / Q000401:mortality* / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011182:Postoperative Care; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant / Q000401:mortality; D018426:SEER Program; D055815:Young Adult