title: Timing of adjuvant radiotherapy and treatment outcome in childhood ependymoma.
abstract: BACKGROUND
  Several trials incorporating adjuvant focal RT for treatment of young children with ependymoma have demonstrated improved survival with acceptable adverse effects. The optimal timing of RT administration is, however, unknown.
  
  
  METHODS
  A retrospective review of territory-wide database was performed to identify pediatric patients with ependymoma diagnosed between 1995 and 2011. OS and EFS were compared between patients receiving upfront RT (<150 days of diagnosis), delayed RT (≥150 days of diagnosis), or no RT.
  
  
  RESULTS
  Thirty-one patients with intracranial ependymoma were identified. Median age was 3.5 years and 14 (45%) were male. Primary tumor was supratentorial in 10 (32%) and infratentorial in 21 (68%). All patients underwent initial surgery, with gross-total resection (GTR) in 27 (87%). Twelve (39%) received upfront RT, 10 (32%) had delayed RT and 9 (29%) had no RT. During the study period, there were 11 relapses (35%) and 10 deaths (32%). Five-year OS was 69.9% and 5yr-EFS was 49.3%. In univariate analysis, GTR led to improved OS (P < 0.001) and EFS (P = 0.004); superior OS and EFS was observed in patients who received RT when compared with those without (P = 0.018 and 0.011, respectively). Upfront RT also resulted in better OS and EFS than delayed RT (P = 0.049 and 0.014, respectively). No significant effect on survival was observed with age, sex, tumor location, RT dosage, and protocol used. In multivariate analysis, GTR significantly improved OS (P = 0.002) and EFS (P = 0.004).
  
  
  CONCLUSIONS
  Our results support the early initiation of adjuvant RT in the multi-modal management of pediatric ependymomas.
authors.affiliation: Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
authors.forename: Anthony Pak-Yin
authors.initials: AP
authors.lastname: Liu
authors.forename: Matthew Ming-Kong
authors.initials: MM
authors.lastname: Shing
authors.forename: Hui-Leung
authors.initials: HL
authors.lastname: Yuen
authors.forename: Chak-Ho
authors.initials: CH
authors.lastname: Li
authors.forename: Siu-Cheung
authors.initials: SC
authors.lastname: Ling
authors.forename: Chung-Wing
authors.initials: CW
authors.lastname: Luk
authors.forename: Shau-Yin
authors.initials: SY
authors.lastname: Ha
authors.forename: Chi-Kong
authors.initials: CK
authors.lastname: Li
authors.forename: Dora Lai-Wan
authors.initials: DL
authors.lastname: Kwong
authors.forename: Godfrey Chi-Fung
authors.initials: GC
authors.lastname: Chan
mesh_terms: D000293:Adolescent; D001932:Brain Neoplasms / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy; D002648:Child; D002675:Child, Preschool; D004806:Ependymoma / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy; D009367:Neoplasm Staging; D011379:Prognosis; D018714:Radiotherapy, Adjuvant / Q000401:mortality*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors
keywords: Ependymoma; children; outcome; radiation therapy