title: Assessing 'second-look' tumour resectability in childhood posterior fossa ependymoma-a centralised review panel and staging tool for future studies.
abstract: OBJECTIVE
  To improve uniformity in radiological review/reporting and discussion of surgical resection status in the forthcoming SIOP Ependymoma II trial, a central review of imaging and resection status will be carried out prior to treatment stratification. We present a review of surgical decision-making from the UKCCSG/SIOP Ependymoma trial for very young children (<3 years) (Lancet Oncol 8:696-705, 2007) and propose a primary surgical staging system for residual disease that could be used for Ependymoma II.
  
  
  METHODS
  Imaging of 89 patients enrolled in the UKCCSG infant Ependymoma trial was independently reviewed by 3 experienced paediatric neuro-oncology surgeons. Pre- and post-op MRI imaging was available for 28 posterior fossa cases with incomplete resection. Location of residual disease, decision to offer 'second-look' surgery (prior to adjuvant therapy), perceived chance of complete resection, and risk to cranial nerves was assessed. Recommendation for second-look surgery was compared with actual second-look surgery.
  
  
  RESULTS
  In the actual study period, 13 patients (46 %) had further surgery at some point. The independent panel, after blinded review of the imaging, would have offered 19 patients overall (68 %) in this same cohort up-front early second-look surgery prior to definitive adjuvant therapy. We devised a 5-point staging system to introduce consistency in staging residual disease and resectability, and this is presented.
  
  
  CONCLUSIONS
  Based on scans alone, a surgical panel would have offered second-look surgery to 68 % of patients with residual ependymoma. The potential benefits and drawbacks of a surgical review panel and classification system will be discussed in the context of the forthcoming Ependymoma II trial.
authors: Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP, UK. christopherpaulmillward@gmail.com.
authors: Christopher P
authors: CP
authors: Millward
authors: Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP, UK.
authors: Conor
authors: C
authors: Mallucci
authors: Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK.
authors: Tim
authors: T
authors: Jaspan
authors: Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK.
authors: Donald
authors: D
authors: Macarthur
authors: Great Ormond Street Hospital, London, UK.
authors: Richard
authors: R
authors: Heyward
authors: Great Ormond Street Hospital, London, UK.
authors: Tim
authors: T
authors: Cox
authors: Great Ormond Street Hospital, London, UK.
authors: Kung
authors: K
authors: Chong
authors: Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK.
authors: Richard G
authors: RG
authors: Grundy
mesh_terms: D002675:Child, Preschool; D003388:Cranial Fossa, Posterior / Q000473:pathology / Q000601:surgery; D004806:Ependymoma / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D009367:Neoplasm Staging / Q000379:methods*; D019292:Skull Base Neoplasms / Q000473:pathology* / Q000601:surgery
keywords: Classification tool; Ependymoma; Review panel; ‘Second-look’ surgery