title: A systematic review of treatment outcomes in pediatric patients with intracranial ependymomas.
abstract: OBJECTIVE
  Ependymoma is the third most common primary brain tumor in children. Tumors are classified according to the WHO pathological grading system. Prior studies have shown high levels of variability in patient outcomes within and across pathological grades. The authors reviewed the results from the published literature on intracranial ependymomas in children to describe clinical outcomes as they relate to treatment modality, associated mortality, and associated progression-free survival (PFS).
  
  
  METHODS
  A search of English language peer-reviewed articles describing patients 18 years of age or younger with intracranial ependymomas yielded data on 182 patients. These patients had undergone treatment for ependymoma with 1 of 5 modalities: 1) gross-total resection (GTR), 2) GTR as well as external beam radiation therapy (EBRT), 3) subtotal resection (STR), 4) STR as well as EBRT, or 5) radiosurgery. Mortality and outcome data were analyzed for time to tumor progression in patients treated with 1 of these 5 treatment modalities.
  
  
  RESULTS
  Of these 182 patients, 69% had supratentorial ependymomas and 31% presented with infratentorial lesions. Regardless of tumor location or pathological grade, STR was associated with the highest rates of mortality. In contrast, GTR was associated with the lowest rates of mortality, the best overall survival, and the longest PFS. Children with WHO Grade II ependymomas had lower mortality rates when treated more aggressively with GTR. However, patients with WHO Grade III tumors had slightly better survival outcomes after a less aggressive surgical debulking (STR+EBRT) when compared with GTR.
  
  
  CONCLUSIONS
  Mortality, PFS, and overall survival vary in pediatric patients with intracranial ependymomas. Pathological classification, tumor location, and method of treatment play a role in outcomes. In this study, GTR was associated with the best overall and PFS rates. Patients with WHO Grade II tumors had better overall survival after GTR+EBRT and better PFS after GTR alone. Patients with WHO Grade III tumors had better overall survival after STR+EBRT. Patients with infratentorial tumors had improved overall survival compared with those with supratentorial tumors. Progression-free survival was best in those patients with infratentorial tumors following STR+EBRT. Consideration of all of these factors is important when counseling families on treatment options.
authors.affiliation: Department of Neurological Surgery, University of California-San Francisco, CA 94143, USA.
authors.forename: Tene A
authors.initials: TA
authors.lastname: Cage
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Clark
authors.forename: Derick
authors.initials: D
authors.lastname: Aranda
authors.forename: Nalin
authors.initials: N
authors.lastname: Gupta
authors.forename: Peter P
authors.initials: PP
authors.lastname: Sun
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Parsa
authors.forename: Kurtis I
authors.initials: KI
authors.lastname: Auguste
mesh_terms: D000293:Adolescent; D001932:Brain Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D018572:Disease-Free Survival; D004806:Ependymoma / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D015192:Infratentorial Neoplasms / Q000628:therapy; D053208:Kaplan-Meier Estimate; D008297:Male; D060787:Neoplasm Grading; D019635:Neurosurgical Procedures / Q000379:methods; D016634:Radiosurgery; D018714:Radiotherapy, Adjuvant; D015173:Supratentorial Neoplasms / Q000628:therapy; D016896:Treatment Outcome