BACKGROUND: Ependymoma is treated with maximal surgical resection and localized radiotherapy. Minimizing unnecessary exposure to radiation is of paramount importance for young children. Proton radiotherapy (PRT) spares healthy tissues outside the target region, but reports of clinical outcomes are scarce. We report outcomes for 70 patients treated with PRT for intracranial ependymoma. METHODS: Seventy patients with localized ependymoma treated with involved-field PRT at the Massachusetts General Hospital between October 2000 and February 2011 were included. RESULTS: Median age at diagnosis was 38 months (range, 3 mo-20 y). Nineteen (27%) patients had supratentorial ependymoma and 51(73%) had infratentorial ependymoma. Forty-six (66%) had gross total resection (GTR), and 24 (34%) had subtotal resection (STR). At a median follow-up of 46 months, 3-year local control, progression-free survival, and overall survival were 83%, 76%, and 95%, respectively. STR was significantly associated with worse progression-free survival (54% vs 88%, P = .001) and overall survival (90% vs 97% for GTR, P = .001). In a subset of patients (n = 14), mean intelligence was 108.5 at baseline and 111.3 after mean 2.05 years of follow-up. In a larger group of patients (n = 28), overall adaptive skills were 100.1 at baseline and 100.8 after 2.21 years of follow-up. Few patients developed evidence of growth hormone deficiency, hypothyroidism, or hearing loss. CONCLUSION: Outcomes for children treated with PRT compare favorably with the literature. STR correlated with inferior outcome. The young age at diagnosis and the proximity of critical structures in patients with ependymoma make PRT an ideal radiation modality.
BACKGROUND:Ependymoma is treated with maximal surgical resection and localized radiotherapy. Minimizing unnecessary exposure to radiation is of paramount importance for young children. Proton radiotherapy (PRT) spares healthy tissues outside the target region, but reports of clinical outcomes are scarce. We report outcomes for 70 patients treated with PRT for intracranial ependymoma. METHODS: Seventy patients with localized ependymoma treated with involved-field PRT at the Massachusetts General Hospital between October 2000 and February 2011 were included. RESULTS: Median age at diagnosis was 38 months (range, 3 mo-20 y). Nineteen (27%) patients had supratentorial ependymoma and 51(73%) had infratentorial ependymoma. Forty-six (66%) had gross total resection (GTR), and 24 (34%) had subtotal resection (STR). At a median follow-up of 46 months, 3-year local control, progression-free survival, and overall survival were 83%, 76%, and 95%, respectively. STR was significantly associated with worse progression-free survival (54% vs 88%, P = .001) and overall survival (90% vs 97% for GTR, P = .001). In a subset of patients (n = 14), mean intelligence was 108.5 at baseline and 111.3 after mean 2.05 years of follow-up. In a larger group of patients (n = 28), overall adaptive skills were 100.1 at baseline and 100.8 after 2.21 years of follow-up. Few patients developed evidence of growth hormone deficiency, hypothyroidism, or hearing loss. CONCLUSION: Outcomes for children treated with PRT compare favorably with the literature. STR correlated with inferior outcome. The young age at diagnosis and the proximity of critical structures in patients with ependymoma make PRT an ideal radiation modality.
Entities:
Keywords:
central nervous system; pediatric ependymoma; proton; radiation
Authors: Matthew Koshy; Shayna Rich; Thomas E Merchant; Usama Mahmood; William F Regine; Young Kwok Journal: J Neurooncol Date: 2011-06-03 Impact factor: 4.130
Authors: J W Goldwein; J M Leahy; R J Packer; L N Sutton; W J Curran; L B Rorke; L Schut; P S Littman; G J D'Angio Journal: Int J Radiat Oncol Biol Phys Date: 1990-12 Impact factor: 7.038
Authors: Thomas E Merchant; Susan R Rose; Christina Bosley; Shengjie Wu; Xiaoping Xiong; Robert H Lustig Journal: J Clin Oncol Date: 2011-10-31 Impact factor: 44.544
Authors: B Timmermann; R D Kortmann; J Kühl; C Meisner; I Slavc; T Pietsch; M Bamberg Journal: Int J Radiat Oncol Biol Phys Date: 2000-01-15 Impact factor: 7.038
Authors: Thomas E Merchant; Olga Goloubeva; David L Pritchard; M Waleed Gaber; Xiaoping Xiong; Robert K Danish; Robert H Lustig Journal: Int J Radiat Oncol Biol Phys Date: 2002-04-01 Impact factor: 7.038
Authors: Thomas E Merchant; Raymond K Mulhern; Matthew J Krasin; Larry E Kun; Tani Williams; Chenghong Li; Xiaoping Xiong; Raja B Khan; Robert H Lustig; Frederick A Boop; Robert A Sanford Journal: J Clin Oncol Date: 2004-08-01 Impact factor: 44.544
Authors: Michal Zapotocky; Kiran Beera; Jenny Adamski; Normand Laperierre; Sharon Guger; Laura Janzen; Alvaro Lassaletta; Liana Figueiredo Nobre; Ute Bartels; Uri Tabori; Cynthia Hawkins; Stacey Urbach; Derek S Tsang; Peter B Dirks; Michael D Taylor; Eric Bouffet; Donald J Mabbott; Vijay Ramaswamy Journal: Cancer Date: 2019-02-15 Impact factor: 6.860
Authors: Santhosh A Upadhyaya; Giles W Robinson; Arzu Onar-Thomas; Brent A Orr; Catherine A Billups; Daniel C Bowers; Anne E Bendel; Tim Hassall; John R Crawford; Sonia Partap; Paul G Fisher; Ruth G Tatevossian; Tiffany Seah; Ibrahim A Qaddoumi; Anna Vinitsky; Gregory T Armstrong; Noah D Sabin; Christopher L Tinkle; Paul Klimo; Danny J Indelicato; Frederick A Boop; Thomas E Merchant; David W Ellison; Amar Gajjar Journal: Neuro Oncol Date: 2019-10-09 Impact factor: 12.300
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: Eveline Teresa Hidalgo; Matija Snuderl; Cordelia Orillac; Svetlana Kvint; Jonathan Serrano; Peter Wu; Matthias A Karajannis; Sharon L Gardner Journal: Childs Nerv Syst Date: 2019-08-02 Impact factor: 1.475
Authors: Margaret B Pulsifer; Roshan V Sethi; Karen A Kuhlthau; Shannon M MacDonald; Nancy J Tarbell; Torunn I Yock Journal: Int J Radiat Oncol Biol Phys Date: 2015-06-14 Impact factor: 7.038