Title | Patterns of relapse for children with localized intracranial ependymoma. |
Publication Type | Journal Article |
Year of Publication | 2018 |
Authors | De B, Khakoo Y, Souweidane MM, Dunkel IJ, Patel SH, Gilheeney SW, De Braganca KC, Karajannis MA, Wolden SL |
Journal | J Neurooncol |
Volume | 138 |
Issue | 2 |
Pagination | 435-445 |
Date Published | 2018 Jun |
ISSN | 1573-7373 |
Keywords | Adolescent, Brain Neoplasms, Child, Child, Preschool, Disease Management, Ependymoma, Female, Follow-Up Studies, Humans, Infant, Infant, Newborn, Male, Recurrence, Retrospective Studies, Survival Analysis, Treatment Outcome, Young Adult |
Abstract | We examined patterns of relapse and prognostic factors in children with intracranial ependymoma. Records of 82 children diagnosed with localized intracranial ependymoma were reviewed. 52% first presented to our institution after relapse. Median age at initial diagnosis was 4 years (range 0-18 years). Gender was 55% male. Initial tumor location was infratentorial in 71% and supratentorial in 29%. Histology was WHO Grade II in 32% and Grade III in 68%. As part of definitive management, 99% had surgery, 70% received RT (26% 2D/3D-conformal RT[CRT], 22% intensity-modulated RT [IMRT], 22% proton), and 37% received chemotherapy. Median follow-up was 4.6 years (range 0.2-32.9). Overall, 74% of patients relapsed (50% local, 17% distant, 7% local + distant) at a median 1.5 (range 0.1-17.5) years. Five-year OS and FFS for patients presenting prior to relapse are 70% (95% confidence interval [CI], 50-83%) and 48% (95% CI 30-64%), respectively. On log-rank, superior overall survival (OS) was demonstrated for gross total resection (p = 0.03). Superior failure-free survival (FFS) was demonstrated for age < 5 years (p = 0.04). No difference in OS or FFS was found between 2D/3D-CRT versus IMRT/proton (p > 0.05). On multivariate analysis, age ≤ 5 was independently associated with a lower risk of death and failure versus older patients (p < 0.05). Contrary to previous reports, young age may not be a poor prognostic factor in patients who can tolerate intensive treatment. Future studies examining patients stratified by clinical and molecular attributes are warranted. |
DOI | 10.1007/s11060-018-2815-7 |
Alternate Journal | J Neurooncol |
PubMed ID | 29511977 |
PubMed Central ID | PMC6756472 |
Grant List | P30 CA008748 / CA / NCI NIH HHS / United States |