title: Re-irradiation of recurrent anaplastic ependymoma using radiosurgery or fractionated stereotactic radiotherapy.
abstract: OBJECTIVE
  Recurrent ependymomas were retreated with stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (FSRT). The efficacy, toxicities, and differences between SRS and FSRT were analyzed.
  
  
  METHODS
  Eight patients with recurrent ependymomas fulfilling the criteria described below were evaluated. Inclusion criteria were: (1) the patient had previously undergone surgery and conventional radiotherapy as first-line treatment; (2) targets were located in or adjacent to the eloquent area or were deep-seated; and (3) the previously irradiated volume overlapped the target lesion.
  
  
  RESULTS
  FSRT was delivered to 18 lesions, SRS to 20 lesions. A median follow-up period was 23 months. The local control rate was 76 % at 3 years. No significant differences in local control were observed due to tumor size or fractionation schedule. Lesions receiving >25 Gy/5 fr or 21 Gy/3 fr did not recur within 1 year, whereas no dose-response relationship was observed in those treated with SRS. No grade ≥2 toxicity was observed.
  
  
  CONCLUSIONS
  Our treatment protocol provided an acceptable LC rate and minimal toxicities. Because local recurrence of tumors may result in patient death, a minimum dose of 21 Gy/3 fr or 25 Gy/5 fr or higher may be most suitable for treatment of these cases.
authors.affiliation: Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan. taro8864@yahoo.co.jp.|Department of Radiology, Tsushima City Hospital, Tsushima, Japan. taro8864@yahoo.co.jp.
authors.forename: Taro
authors.initials: T
authors.lastname: Murai
authors.affiliation: Department of Neurosurgery, Japanese Red Cross Medical Center, Tokyo, Japan.|Yokohama CyberKnife Center, Yokohama, Japan.
authors.forename: Kengo
authors.initials: K
authors.lastname: Sato
authors.affiliation: Department of Neurosurgery, Japanese Red Cross Medical Center, Tokyo, Japan.
authors.forename: Michio
authors.initials: M
authors.lastname: Iwabuchi
authors.affiliation: Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Manabe
authors.affiliation: Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ogino
authors.affiliation: Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Japan.
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Iwata
authors.affiliation: Yokohama CyberKnife Center, Yokohama, Japan.
authors.forename: Koshi
authors.initials: K
authors.lastname: Tatewaki
authors.affiliation: Radiation Oncology Center, Suzukake Central Hospital, Hamamatsu, Shizuoka, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Yokota
authors.affiliation: Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Ohta
authors.affiliation: Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
authors.forename: Yuta
authors.initials: Y
authors.lastname: Shibamoto
mesh_terms: D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000532:radiotherapy*; D002648:Child; D019583:Dose Fractionation, Radiation; D004806:Ependymoma / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D016634:Radiosurgery; D000069475:Re-Irradiation; D016896:Treatment Outcome; D055815:Young Adult
keywords: CyberKnife; Fractionated stereotactic radiotherapy; Re-irradiation; Recurrent ependymoma