Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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Postoperative radiotherapy for ependymoma

  • Jung, Jinhong (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choi, Wonsik (Department of Radiation Oncology, Gangneung Asan Hospital) ;
  • Ahn, Seung Do (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Jin Hong (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Su Ssan (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Young Seok (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yoon, Sang Min (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Song, Si Yeol (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Sang-Wook (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Jong Hoon (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choi, Eun Kyung (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2012.08.30
  • Accepted : 2012.10.17
  • Published : 2012.12.30
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Abstract

Purpose: To evaluated the patterns of failure, survival rate, treatment-related toxicity and prognostic factors in postoperative radiotherapy of patients with ependymoma. Materials and Methods: Thirty patients who underwent surgery and postoperative radiotherapy for ependymoma between the period of June 1994 and June 2008 were reviewed retrospectively. The age of patients ranged from 21 months to 66 years (median, 19 years). Seventeen patients had grade II ependymoma, and 13 had grade III anaplastic ependymoma according to the World Health Organization grading system. The postoperative irradiation was performed with 4 or 6 MV photon beam with median dose of 52.8 Gy (range, 45 to 63 Gy), and radiation field including 2 cm beyond the preoperative tumor volume. Median follow-up period was 51 months (range, 12 to 172 months). Results: Fourteen out of 30 (46.7%) patients experienced recurrence, and 12 of those died. Among those 14 patients who experienced recurrence, 11 were in-field and 3 were out-of-field recurrence. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 66.7% and 56.1%, respectively. On univariate analysis, tumor grade was a statistically significant prognostic factor for OS and PFS. There were two complications after surgery and postoperative radiotherapy, including short stature and facial palsy on the left side. Conclusion: We observed good survival rates, and histologic grade was a prognostic factor affecting the OS and PFS. Almost all recurrence occurred in primary tumor site, thus we suggest further evaluation on intensity-modulated radiotherapy or stereotatic radiosurgery for high-risk patients such as who have anaplastic ependymoma.

Keywords

References

  1. Gurney JG, Smith MA, Bunin GR. CNS and miscellaneous intracranial and intraspinal neoplasms. In: Ries LA, Smith MA, Gurney JG, et al. Cancer incidence and survival among children and adolescents: United States SEER program 1975-1995. Bethesda, MD: National Cancer Institute; 1999. p. 51-64.
  2. Louis DN, Ohgaki H, Wiestler OD, et al. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 2007;114:97-109. https://doi.org/10.1007/s00401-007-0243-4
  3. Merchant TE, Fouladi M. Ependymoma: new therapeutic approaches including radiation and chemotherapy. J Neurooncol 2005;75:287-99. https://doi.org/10.1007/s11060-005-6753-9
  4. Merchant TE, Zhu Y, Thompson SJ, Sontag MR, Heideman RL, Kun LE. Preliminary results from a phase II trail of conformal radiation therapy for pediatric patients with localised lowgrade astrocytoma and ependymoma. Int J Radiat Oncol BiolPhys 2002;52:325-32. https://doi.org/10.1016/S0360-3016(01)01807-7
  5. Pollack IF, Gerszten PC, Martinez AJ, et al. Intracranial ependymomas of childhood: long-term outcome and prognostic factors. Neurosurgery 1995;37:655-66. https://doi.org/10.1227/00006123-199510000-00008
  6. Rousseau P, Habrand JL, Sarrazin D, et al. Treatment of intracranial ependymomas of children: review of a 15-year experience. Int J Radiat Oncol Biol Phys 1994;28:381-6. https://doi.org/10.1016/0360-3016(94)90061-2
  7. Guyotat J, Signorelli F, Desme S, et al. Intracranial ependymomas in adult patients: analyses of prognostic factors. J Neurooncol 2002;60:255-68. https://doi.org/10.1023/A:1021136029072
  8. Metellus P, Barrie M, Figarella-Branger D, et al. Multicentric French study on adult intracranial ependymomas: prognostic factors analysis and therapeutic considerations from a cohort of 152 patients. Brain 2007;130:1338-49. https://doi.org/10.1093/brain/awm046
  9. Reni M, Brandes AA, Vavassori V, et al. A multicenter study of the prognosis and treatment of adult brain ependymal tumors. Cancer 2004;100:1221-9. https://doi.org/10.1002/cncr.20074
  10. Shu HK, Sall WF, Maity A, et al. Childhood intracranial ependymoma: twenty-year experience from a single institution. Cancer 2007;110:432-41. https://doi.org/10.1002/cncr.22782
  11. Horn B, Heideman R, Geyer R, et al. A multi-institutional retrospective study of intracranial ependymoma in children: identification of risk factors. J Pediatr Hematol Oncol 1999;21:203-11. https://doi.org/10.1097/00043426-199905000-00008
  12. Merchant TE, Jenkins JJ, Burger PC, et al. Influence of tumor grade on time to progression after irradiation for localizedependymoma in children. Int J Radiat Oncol Biol Phys 2002;53:52-7. https://doi.org/10.1016/S0360-3016(01)02801-2
  13. Korshunov A, Golanov A, Sycheva R, Timirgaz V. The histologic grade is a main prognostic factor for patients with intracranial ependymomas treated in the microneurosurgical era: an analysis of 258 patients. Cancer 2004;100:1230-7. https://doi.org/10.1002/cncr.20075
  14. Kawabata Y, Takahashi JA, Arakawa Y, Hashimoto N. Longterm outcome in patients harboring intracranial ependymoma. J Neurosurg 2005;103:31-7. https://doi.org/10.3171/jns.2005.103.1.0031
  15. Kurt E, Zheng PP, Hop WC, et al. Identification of relevant prognostic histopathologic features in 69 intracranial ependymomas, excluding myxopapillary ependymomas and subependymomas. Cancer 2006;106:388-95. https://doi.org/10.1002/cncr.21608
  16. Wolfsberger S, Fischer I, Hoftberger R, et al. Ki-67 immunolabeling index is an accurate predictor of outcome in patients with intracranial ependymoma. Am J Surg Pathol 2004;28:914-20. https://doi.org/10.1097/00000478-200407000-00011
  17. Timmermann B, Kortmann RD, Kuhl J, et al. Combined postoperative irradiation and chemotherapy for anaplastic ependymomas in childhood: results of the German prospective trials HIT 88/89 and HIT 91. Int J Radiat Oncol Biol Phys 2000;46:287-95. https://doi.org/10.1016/S0360-3016(99)00414-9
  18. Needle MN, Goldwein JW, Grass J, et al. Adjuvant chemotherapy for the treatment of intracranial ependymoma of childhood. Cancer 1997;80:341-7. https://doi.org/10.1002/(SICI)1097-0142(19970715)80:2<341::AID-CNCR23>3.0.CO;2-T
  19. Kricheff II, Becker M, Schneck SA, Taveras JM. Intracranial ependymomas: a study of survival in 65 cases treated by surgery and irradiation. Am J Roentgenol Radium Ther Nucl Med 1964;91:167-75.
  20. Perilongo G, Massimino M, Sotti G, et al. Analyses of prognostic factors in a retrospective review of 92 children with ependymoma: Italian Pediatric Neuro-oncology Group. Med Pediatr Oncol 1997;29:79-85. https://doi.org/10.1002/(SICI)1096-911X(199708)29:2<79::AID-MPO3>3.0.CO;2-O
  21. Rezai AR, Woo HH, Lee M, Cohen H, Zagzag D, Epstein FJ. Disseminated ependymomas of the central nervous system. J Neurosurg 1996;85:618-24. https://doi.org/10.3171/jns.1996.85.4.0618
  22. Merchant TE, Haida T, Wang MH, Finlay JL, Leibel SA. Anaplastic ependymoma: treatment of pediatric patients with or without craniospinal radiation therapy. J Neurosurg 1997;86:943-9. https://doi.org/10.3171/jns.1997.86.6.0943
  23. Aggarwal R, Yeung D, Kumar P, Muhlbauer M, Kun LE. Efficacy and feasibility of stereotactic radiosurgery in the primary management of unfavorable pediatric ependymoma. Radiother Oncol 1997;43:269-73. https://doi.org/10.1016/S0167-8140(97)01926-9

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