title: Re-irradiation of recurrent pediatric ependymoma: modalities and outcomes: a twenty-year survey.
abstract: BACKGROUND
  Standard treatment for recurrent ependymomas is not defined. Re- irradiation has been proposed but its modalities and results are still to be explored.
  
  
  METHODS
  From June 1994 to December 2013, 32 pediatric patients with ependymoma were re-irradiated for local (n = 15) or metastatic (n = 17) relapses. Files were reviewed retrospectively.
  
  
  RESULTS
  Local relapses were treated with hypofractionated focal radiotherapy (hypoFFRT) (n = 8) or focal fractionated radiotherapy (FFRT) (n = 7). Metastatic relapses were treated with hypoFFRT (n = 3), FFRT (n = 3), spinal radiotherapy (n = 4) and craniospinal irradiation (CSI) (n = 7). Median PFS and OS after re-irradiation were 1.2 and 3.5 years respectively with a median follow-up of 2.1 years (0.2-11.4). For local relapses, median PFS was 2.5 years for patients treated with hypoFFRT versus 1.2 years for patients treated with FFRT (p = 0.2). For metastatic relapses, median PFS was 0.7 years for patients treated with focal radiotherapy (hypoFFRT, FFRT, spinal radiotherapy) versus 6.8 years for patients treated with CSI (p = 0.073). 15 patients achieved greater PFS after second radiotherapy (RT2) than after first radiotherapy (RT1). 27 patients (84 %) had surgery before re-irradiation. PFS was better for patients with GTR before RT2 (14.7 vs 6.7 months) (p = 0.05). 5 patients developed radionecrosis; only one required corticosteroids.
  
  
  CONCLUSIONS
  Re-irradiation at relapse is a safe, feasible and potentially curative treatment. Metastatic relapse may require CSI even when isolated and re-operated. For local relapses, considering conflicting results in the literature, a randomized trial is warranted to explore fractionated focal radiotherapy versus hypofractionated focal irradiation.
authors.affiliation: Department of Pediatric and Adolescent Oncology, University Paris Sud Villejuif, Gustave Roussy, 114 Rue Edouard Vaillant, 94805 Villejuif, France.
authors.forename: Maria Jesus
authors.initials: MJ
authors.lastname: Lobón
authors.affiliation: Department of Pediatric and Adolescent Oncology, University Paris Sud Villejuif, Gustave Roussy, 114 Rue Edouard Vaillant, 94805 Villejuif, France.
authors.forename: Francisco
authors.initials: F
authors.lastname: Bautista
authors.affiliation: Department of Radiotherapy, University Paris Sud Villejuif, Villejuif, France.
authors.forename: François
authors.initials: F
authors.lastname: Riet
authors.affiliation: Department of Radiotherapy, University Paris Sud Villejuif, Villejuif, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Dhermain
authors.affiliation: Department of Radiology Gustave Roussy, University Paris Sud Villejuif, Villejuif, France.
authors.forename: Sandra
authors.initials: S
authors.lastname: Canale
authors.affiliation: Department of Pediatric and Adolescent Oncology, University Paris Sud Villejuif, Gustave Roussy, 114 Rue Edouard Vaillant, 94805 Villejuif, France.
authors.forename: Christelle
authors.initials: C
authors.lastname: Dufour
authors.affiliation: Department of Neurosurgery, Hôpital Necker Enfants-Malades, Paris, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Blauwblomme
authors.affiliation: Department of Neurosurgery, Hôpital Necker Enfants-Malades, Paris, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Zerah
authors.affiliation: Department of Neurosurgery, Hôpital Necker Enfants-Malades, Paris, France.
authors.forename: Kevin
authors.initials: K
authors.lastname: Beccaria
authors.affiliation: Department of Neurosurgery, Hôpital Necker Enfants-Malades, Paris, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Saint-Rose
authors.affiliation: Department of Neurosurgery, Hôpital Necker Enfants-Malades, Paris, France.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Puget
authors.affiliation: Department of Radiotherapy, Centre Léon Bérard, Lyon, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Carrie
authors.affiliation: Centre Oscar Lambret, Lille, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Lartigau
authors.affiliation: Centre Antoine-Lacassagne, Nice, France.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Bondiau
authors.affiliation: Department of Pediatric and Adolescent Oncology, University Paris Sud Villejuif, Gustave Roussy, 114 Rue Edouard Vaillant, 94805 Villejuif, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Valteau-Couanet
authors.affiliation: Department of Pediatric and Adolescent Oncology, University Paris Sud Villejuif, Gustave Roussy, 114 Rue Edouard Vaillant, 94805 Villejuif, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Grill
authors.affiliation: Department of Radiotherapy, University Paris Sud Villejuif, Villejuif, France.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Bolle
keywords: Children; Ependymoma; Radiosurgery; Radiotherapy; Recurrent