Hyperfractionated radiotherapy and chemotherapy for childhood ependymoma: final results of the first prospective AIEOP (Associazione Italiana di Ematologia-Oncologia Pediatrica) study.

Abstract

PURPOSE:

A postsurgical "stage-based" protocol for ependymoma was designed.

METHODS AND MATERIALS:

Children were given: (1) focal hyperfractionated radiotherapy (HFRT) if with no evidence of disease (NED), or (2) 4 courses with VEC followed by HFRT for residual disease (ED). HFRT dose was 70.4 Gy (1.1 Gy/fraction b.i.d.); VEC consisted of VCR 1.5 mg/m2 1/w, VP16 100 mg/m2/day x 3, CTX 3 g/m2 d 1. When feasible, second-look surgery was recommended.

RESULTS:

Sixty-three consecutive children were enrolled: 46 NED, 17 ED; the tumor was infratentorial in 47 and supratentorial in 16, with spinal metastasis in 1. Of NED patients, 35 of 46 have been treated with HFRT; 8 received conventionally fractionated radiotherapy, and 3 received no treatment. Of the 17 ED patients, 9 received VEC + HFRT; violations due to postsurgical morbidity were as follows: HFRT only (2), conventionally fractionated radiotherapy (3) + VEC (2), and no therapy (1). Objective responses to VEC were seen in 54%; objective responses to RT were seen in 75%. Overall survival and progression-free survival at 5 years for all 63 children were 75% and 56%, respectively; for the NED subgroup, 82% and 65%; and for the ED subgroup, 61% and 35%, respectively. All histologies were centrally reviewed. At multivariate analysis, grading, age, and site proved significant for prognosis.

CONCLUSIONS:

HFRT, despite the high total dose adopted, did not change the prognosis of childhood ependymoma as compared to historical series: New radiotherapeutic approaches are needed to improve local control. Future ependymoma strategies should consider grading when stratifying treatment indications.

• Authors: Maura Massimino, Lorenza Gandola, Felice Giangaspero, Alessandro Sandri, Pinuccia Valagussa, Giorgio Perilongo, Maria Luisa Garrè, Umberto Ricardi, Marco Forni, Lorenzo Genitori, Giovanni Scarzello, Filippo Spreafico, Salvina Barra, Maurizio Mascarin, Bianca Pollo, Martina Gardiman, Armando Cama, Pierina Navarria, Maurizio Brisigotti, Paola Collini, Rita Balter, Paola Fidani, Maurizio Stefanelli, Roberta Burnelli, Paolo Potepan, Marta Podda, Guido Sotti, Enrico Madon, AIEOP Pediatric Neuro-Oncology Group
• Journal: International journal of radiation oncology, biology, physics (Int J Radiat Oncol Biol Phys) Vol. 58 Issue 5 Pg. 1336-45 (Apr 01 2004) ISSN: 0360-3016 [Print] United States
• PMID: 15050308 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Vincristine
• Etoposide
• Cyclophosphamide

Topics

• Adolescent
• Adult
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Brain Neoplasms (drug therapy, radiotherapy, surgery)
• Chemotherapy, Adjuvant
• Child
• Child, Preschool
• Cyclophosphamide (administration & dosage)
• Dose Fractionation, Radiation
• Ependymoma (drug therapy, radiotherapy, surgery)
• Etoposide (administration & dosage)
• Feasibility Studies
• Humans
• Infratentorial Neoplasms (drug therapy, radiotherapy, surgery)
• Patient Compliance
• Prospective Studies
• Radiotherapy, Adjuvant
• Supratentorial Neoplasms (drug therapy, radiotherapy, surgery)
• Survival Analysis
• Vincristine (administration & dosage)