PURPOSE: To determine the patterns of failure after intensity-modulated radiation therapy (IMRT) for localized intracranial ependymoma. METHODS AND MATERIALS: From 1994 to 2005, 22 children with pathologically proven, localized, intracranial ependymoma were treated with adjuvant IMRT. Of the patients, 12 (55%) had an infratentorial tumor and 14 (64%) had anaplastic histology. Five patients had a subtotal resection (STR), as evidenced by postoperative magnetic resonance imaging. The clinical target volume encompassed the tumor bed and any residual disease plus margin (median dose 54 Gy). Median follow-up for surviving patients was 39.8 months. RESULTS: The 3-year overall survival rate was 87% +/- 9%. The 3-year local control rate was 68% +/- 12%. There were six local recurrences, all in the high-dose region of the treatment field. Median time to recurrence was 21.7 months. Of the 5 STR patients, 4 experienced recurrence and 3 died. Patients with a gross total resection had significantly better local control (p = 0.024) and overall survival (p = 0.008) than those with an STR. At last follow-up, no patient had developed visual loss, brain necrosis, myelitis, or a second malignancy. CONCLUSIONS: Treatment with IMRT provides local control and survival rates comparable with those in historic publications using larger treatment volumes. All failures were within the high-dose region, suggesting that IMRT does not diminish local control. The degree of surgical resection was shown to be significant for local control and survival.
PURPOSE: To determine the patterns of failure after intensity-modulated radiation therapy (IMRT) for localized intracranial ependymoma. METHODS AND MATERIALS: From 1994 to 2005, 22 children with pathologically proven, localized, intracranial ependymoma were treated with adjuvant IMRT. Of the patients, 12 (55%) had an infratentorial tumor and 14 (64%) had anaplastic histology. Five patients had a subtotal resection (STR), as evidenced by postoperative magnetic resonance imaging. The clinical target volume encompassed the tumor bed and any residual disease plus margin (median dose 54 Gy). Median follow-up for surviving patients was 39.8 months. RESULTS: The 3-year overall survival rate was 87% +/- 9%. The 3-year local control rate was 68% +/- 12%. There were six local recurrences, all in the high-dose region of the treatment field. Median time to recurrence was 21.7 months. Of the 5 STR patients, 4 experienced recurrence and 3 died. Patients with a gross total resection had significantly better local control (p = 0.024) and overall survival (p = 0.008) than those with an STR. At last follow-up, no patient had developed visual loss, brain necrosis, myelitis, or a second malignancy. CONCLUSIONS: Treatment with IMRT provides local control and survival rates comparable with those in historic publications using larger treatment volumes. All failures were within the high-dose region, suggesting that IMRT does not diminish local control. The degree of surgical resection was shown to be significant for local control and survival.
Authors: Brian De; Yasmin Khakoo; Mark M Souweidane; Ira J Dunkel; Suchit H Patel; Stephen W Gilheeney; Kevin C De Braganca; Matthias A Karajannis; Suzanne L Wolden Journal: J Neurooncol Date: 2018-03-06 Impact factor: 4.130
Authors: Thomas E Merchant; Chenghong Li; Xiaoping Xiong; Larry E Kun; Frederic A Boop; Robert A Sanford Journal: Lancet Oncol Date: 2009-03 Impact factor: 41.316
Authors: Florian Sterzing; Eva M Stoiber; Simeon Nill; Harald Bauer; Peter Huber; Jürgen Debus; Marc W Münter Journal: Radiat Oncol Date: 2009-09-23 Impact factor: 3.481