Outcomes after re-irradiation for recurrent pediatric intracranial ependymoma

Publication date: Available online 13 October 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Derek S. Tsang, Elizabeth Burghen, Paul Klimo, Frederick A. Boop, David W. Ellison, Thomas E. Merchant
PurposeRe-irradiation for recurrent pediatric ependymoma is feasible and safe, but the long-term outcomes and the optimal dose and volume for re-treatment are unknown.Methods and MaterialsPatients with recurrent ependymoma treated with a second course of fractionated radiotherapy (RT2) were reviewed retrospectively. Eligible patients had localized, intracranial ependymoma at initial diagnosis that was treated with focal radiation (RT1) without craniospinal irradiation (CSI-RT1), and were aged ≤21 years at the time of RT2. The median doses of RT1, focal RT2, and CSI-RT2 were 59.4, 54, and 39.6 Gy, respectively. The primary endpoint, overall survival (OS), was measured from the first day of RT2.ResultsWe included 101 patients in the study. The median interval between RT1 and RT2 was 26.8 months (interquartile range [IQR] 18.0–43.1). The median durations of OS and freedom from progression (FFP) were 75.1 and 27.3 months, respectively. Male sex and anaplastic histology at recurrence were associated with decreased OS and FFP on multivariate analysis. Distant-only failure treated with CSI-RT2 was independently associated with improved OS compared to individuals with local failure treated with focal RT2 (HR 0.37, 95% CI 0.16–0.87). Among individuals experiencing any distant failure after RT1, gain of chromosome 1q was adversely associated with poorer OS (HR 3.5, 95% CI 1.1–10.6). No distant-only failures were observed in individuals with RT1 local failure who received CSI-RT2 (n = 10). The 10-year cumulative incidence of grade ≥3 radiation necrosis after RT2 was 7.9%.ConclusionsRe-irradiation for relapsed pediatric ependymoma was well tolerated by most patients and resulted in long-term survival in a subset of patients. The best results were observed in patients who experienced distant-only failure after RT1 and were treated with CSI as part of RT2, without anaplasia at recurrence. The option of re-irradiation should be discussed with patients who develop recurrent ependymoma.

Teaser

Repeat radiation therapy (RT) for recurrent pediatric ependymoma results in long-term disease control in some patients. Five-year survival was 57% for all patients. Patients with distant-only failure treated with craniospinal irradiation had the best outcomes (5-year survival of 76%). The 10-year incidence of grade 3 or higher radiation necrosis was low at 7.9%. Repeat RT is a feasible, safe, and effective treatment for children with recurrent ependymoma.


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