title: Survival benefit for pediatric patients with recurrent ependymoma treated with reirradiation.
abstract: OBJECTIVE
  The outcome of recurrent ependymoma in children is dismal. Reirradiation has been proposed as an effective modality for ependymoma at relapse. However, the toxicity and outcome benefits of this approach have not been well established.
  
  
  METHODS
  We conducted a retrospective population-based study of all patients with recurrent ependymoma treated between 1986 and 2010 in our institution. Demographic, treatment, and outcome data were analyzed for the entire cohort.
  
  
  RESULTS
  Of 113 patients with intracranial ependymoma, 47 patients relapsed. At the time of relapse, 29 patients were treated with surgical resection and/or chemotherapy, and 18 patients received full-dose (≥ 54 Gy focal and/or craniospinal) reirradiation with or without surgery at recurrence. Reirradiation was tolerated well with no severe acute complications noticed. Three-year overall survival was 7% ± 6% and 81% ± 12% for nonreirradiated and reirradiated patients, respectively (p < 0.0001). Time to second progression after reirradiation was significantly longer than time to first progression. This surprising phenomenon was associated with improved progression-free survival for tumors with evidence of DNA damage (n = 15; p = 0.002). At a mean follow-up of 3.73 years, only 2/18 patients had endocrine dysfunction, and 1 patient required special education support. However, a decline in intellectual function from pre- to postreirradiation assessment was observed.
  
  
  CONCLUSIONS
  Reirradiation is an effective treatment that may change the natural history of recurrent ependymoma in children. However, this change may be associated with increased neurocognitive toxicity. Additional follow-up is needed to determine the risk of late recurrence, secondary radiation-induced tumors, and long-term functional outcome of these patients.
authors.affiliation: Department of Hematology/Oncology, The Hospital for Sick Children, and University of Toronto, Toronto, Ontario, Canada. eric.bouffet@sickkids.ca
authors.forename: Eric
authors.initials: E
authors.lastname: Bouffet
authors.forename: Cynthia E
authors.initials: CE
authors.lastname: Hawkins
authors.forename: Walid
authors.initials: W
authors.lastname: Ballourah
authors.forename: Michael D
authors.initials: MD
authors.lastname: Taylor
authors.forename: Ute K
authors.initials: UK
authors.lastname: Bartels
authors.forename: Nicholas
authors.initials: N
authors.lastname: Schoenhoff
authors.forename: Elena
authors.initials: E
authors.lastname: Tsangaris
authors.forename: Annie
authors.initials: A
authors.lastname: Huang
authors.forename: Abhaya
authors.initials: A
authors.lastname: Kulkarni
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Mabbot
authors.forename: Normand
authors.initials: N
authors.lastname: Laperriere
authors.forename: Uri
authors.initials: U
authors.lastname: Tabori
mesh_terms: D001932:Brain Neoplasms / Q000401:mortality* / Q000532:radiotherapy*; D002648:Child; D002675:Child, Preschool; D004806:Ependymoma / Q000401:mortality* / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D007223:Infant; D007361:Intelligence Tests; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000532:radiotherapy*; D009864:Ontario; D011879:Radiotherapy Dosage; D019233:Retreatment / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D016019:Survival Analysis