title: Pediatric intracranial ependymoma: the roles of surgery, radiation and chemotherapy.
abstract: Management of pediatric intracranial ependymomas poses a major challenge, and optimal treatment remains controversial. We sought to investigate the roles of surgery, radiation, and chemotherapy in a historical cohort. Thirty-nine children, age 21 or younger, with non-metastatic intracranial ependymomas were treated from 1972 to 2008. Median age was 8 years (range 0.2-19.1). Twenty-one patients (54%) underwent GTRs, and 18 (45%) underwent STRs. Twenty-six patients (67%) received upfront adjuvant RT (67%), and 14 (44%) received adjuvant chemotherapy. Twenty-four patients had disease recurrence and 12 died. Only one patient recurred after 5 years. Median PFS was 2.7 years and median OS was 20 years. Fifteen year PFS and OS were 30 and 67%. Adjuvant RT was associated with improved PFS (P = 0.045), and remained significant after adjusting for EOR (P = 0.04). Greater EOR trended towards prolonged survival, but did not reach statistical significance (P = 0.156). Of the patients that underwent GTR, the median PFS was 38 months for those treated with adjuvant RT versus 30 months for those that were not treated with RT. Of the patients that had STR, the median PFS for those treated with RT was 26.3 months versus 6.9 months for those were not treated with RT. In conclusion, for localized intracranial pediatric ependymomas, adjuvant RT is associated with improved PFS, even after adjusting for EOR. Our findings suggest the benefit of RT even in the presence of GTR. Future prospective studies with larger sample number are needed to validate our findings.
authors.affiliation: Department of Radiation Oncology, University of California, San Francisco and UCSF Benioff Children's Hospital, 1600 Divisadero Street, Suite H1031, San Francisco, CA 94115-1708, USA.
authors.forename: Sunanda
authors.initials: S
authors.lastname: Pejavar
authors.forename: Mei-Yin
authors.initials: MY
authors.lastname: Polley
authors.forename: Sarah
authors.initials: S
authors.lastname: Rosenberg-Wohl
authors.forename: Sravana
authors.initials: S
authors.lastname: Chennupati
authors.forename: Michael D
authors.initials: MD
authors.lastname: Prados
authors.forename: Mitchel S
authors.initials: MS
authors.lastname: Berger
authors.forename: Anuradha
authors.initials: A
authors.lastname: Banerjee
authors.forename: Nalin
authors.initials: N
authors.lastname: Gupta
authors.forename: Daphne
authors.initials: D
authors.lastname: Haas-Kogan
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004806:Ependymoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D060787:Neoplasm Grading; D019635:Neurosurgical Procedures; D011379:Prognosis; D016016:Proportional Hazards Models; D011878:Radiotherapy; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents