title: Second-look surgery for ependymoma: the Italian experience.
abstract: OBJECTIVE
  Complete ependymoma resection ensures a better prognosis for children with this tumor, but the complete excision of infratentorial ependymomas involves serious risks. Second-look surgery for tumor remnants may be less harmful and enable complete removal. There is a potential, although still unclear, role for neoadjuvant chemotherapy in preparation for further surgery.
  
  
  METHODS
  Since 1994, the authors have adopted two successive protocols for intracranial ependymoma, both including a phase of adjuvant chemotherapy for children with surgical tumor remnants with a plan for potential second-look surgery before radiotherapy.
  
  
  RESULTS
  In the first protocol, 9 of 63 children underwent further surgery, and 6 became tumor free with no additional sequelae. Their prognosis for progression-free survival and freedom from local relapse was comparable to that of children who were operated on only once. In the second protocol, efforts were made to achieve complete resection and 29 of 110 patients underwent reoperations: 9 after the first surgery, 17 after chemotherapy, and 3 soon after radiotherapy. Fourteen of the 29 patients became tumor free, 1 of them with worsening neurological symptoms. The outcome of the 66 patients who became tumor free after 1 operation was compared with that of the 14 who became tumor free after reoperation. The 3-year progression-free survival of the 66 patients compared with the 14 other patients was 71.4% ± 6.9% and 90% ± 9.5%, respectively; the 3-year freedom from local relapse was 84.7% ± 5.9% and 90% ± 9.5%, respectively; and the 3-year overall survival was 85.9% ± 5.4% and 87.5% ± 11.7%, respectively.
  
  
  CONCLUSIONS
  Second-look surgery proved feasible with no major morbidity, and results improved with time. Local tumor control was comparable in patients undergoing 1 or more resections.
authors: Pediatric Unit, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale Tumori, Milano, Italy. maura.massimino@istitutotumori.mi.it
authors: Maura
authors: M
authors: Massimino
authors: Carlo Lazzaro
authors: CL
authors: Solero
authors: Maria Luisa
authors: ML
authors: Garrè
authors: Veronica
authors: V
authors: Biassoni
authors: Armando
authors: A
authors: Cama
authors: Lorenzo
authors: L
authors: Genitori
authors: Concezio
authors: C
authors: Di Rocco
authors: Iacopo
authors: I
authors: Sardi
authors: Elisabetta
authors: E
authors: Viscardi
authors: Piergiorgio
authors: P
authors: Modena
authors: Paolo
authors: P
authors: Potepan
authors: Salvina
authors: S
authors: Barra
authors: Giovanni
authors: G
authors: Scarzello
authors: Ercole
authors: E
authors: Galassi
authors: Felice
authors: F
authors: Giangaspero
authors: Manila
authors: M
authors: Antonelli
authors: Lorenza
authors: L
authors: Gandola
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant / Q000379:methods; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004806:Ependymoma / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015192:Infratentorial Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery*; D007558:Italy / Q000453:epidemiology; D008297:Male; D009017:Morbidity; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents