Fatima Tensaouti1, Anne Ducassou2, Léonor Chaltiel3, Annick Sevely4, Stéphanie Bolle5, Laetitia Padovani6, Anais Jouin7, Claire Alapetite8, Stéphane Supiot9, Aymeri Huchet10, Valérie Bernier11, Line Claude12, Christine Kerr13, Elisabeth Le Prisé14, Anne-Isabelle Bertozzi-Salamon15, Samuel Liceaga16, Jean Albert Lotterie17, Patrice Péran16, Anne Laprie18. 1. ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France. Electronic address: fatima.tensaouti@inserm.fr. 2. Department of Radiation Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole, France. 3. Department of Biostatistics, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, France. 4. Department of Radiology, CHU Purpan, Toulouse, France. 5. Department of Radiation Oncology, Institut Gustave Roussy, Paris, France. 6. Department of Radiation Oncology, CHU La Timone, Marseille, France. 7. Department of Radiation Oncology, Centre Oscar Lambret, Lille, France. 8. Department of Radiation Oncology, Institut Curie, Paris, France. 9. Department of Radiation Oncology, Institut de cancérologie de l'ouest, Nantes, France. 10. Department of Radiation Oncology, CHU Bordeaux, France. 11. Department of Radiation Oncology, Centre Alexis Vautrin, Nancy, France. 12. Department of Radiation Oncology, Centre Léon Bérard, Lyon, France. 13. Department of Radiation Oncology, Institut régional du Cancer de Montpellier, France. 14. Department of Radiation Oncology, Centre Eugènes Marquis, Rennes, France. 15. Department of Pediatric, Hematology-Oncology Unit, CHU Purpan, Toulouse, France. 16. ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France. 17. Department of Nuclear Medicine, CHU Rangueil, Toulouse, France; ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France. 18. ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France; Department of Radiation Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole, France.
Abstract
BACKGROUND AND PURPOSE: Ependymoma is the third most common brain tumor in children. Radiation therapy (RT) is systematically administered after maximum surgical resection, utilizing recent advances in radiation delivery. Imaging can make a significant contribution to improving treatment outcome. This prompted us to look for significant preoperative and postoperative imaging markers for survival. MATERIAL AND METHODS: We undertook a national retrospective review of 121 patients who had undergone resection followed by RT. Preoperative tumor volumes on T1 and FLAIR images were delineated, together with postoperative hyperintense volumes on FLAIR images. Overall survival (OS) and disease-free survival (DFS) analyses included clinical data and volumes extracted from images. RESULTS: After a median follow-up of 38.5 months, 80.2% of patients were alive, but 39.7% had experienced at least one event. Statistically significant differences between patients with and without postoperative FLAIR abnormalities were found for both DFS (71.9% vs. 40.3%; p = 0.006) and OS (93.7% vs. 72.4%; p = 0.023) in the univariate analyses, and for OS (p = 0.049) in the multivariate analyses. CONCLUSIONS: Postoperative FLAIR hyperintensities are a negative prognostic factor for intracranial ependymoma and may be a surrogate for residual disease. They could therefore prove helpful in patients' surgical and radiotherapeutic management.
BACKGROUND AND PURPOSE:Ependymoma is the third most common brain tumor in children. Radiation therapy (RT) is systematically administered after maximum surgical resection, utilizing recent advances in radiation delivery. Imaging can make a significant contribution to improving treatment outcome. This prompted us to look for significant preoperative and postoperative imaging markers for survival. MATERIAL AND METHODS: We undertook a national retrospective review of 121 patients who had undergone resection followed by RT. Preoperative tumor volumes on T1 and FLAIR images were delineated, together with postoperative hyperintense volumes on FLAIR images. Overall survival (OS) and disease-free survival (DFS) analyses included clinical data and volumes extracted from images. RESULTS: After a median follow-up of 38.5 months, 80.2% of patients were alive, but 39.7% had experienced at least one event. Statistically significant differences between patients with and without postoperative FLAIR abnormalities were found for both DFS (71.9% vs. 40.3%; p = 0.006) and OS (93.7% vs. 72.4%; p = 0.023) in the univariate analyses, and for OS (p = 0.049) in the multivariate analyses. CONCLUSIONS: Postoperative FLAIR hyperintensities are a negative prognostic factor for intracranial ependymoma and may be a surrogate for residual disease. They could therefore prove helpful in patients' surgical and radiotherapeutic management.