Maura Massimino1, Francesco Barretta2, Piergiorgio Modena3, Felice Giangaspero4,5, Luisa Chiapparini6, Alessandra Erbetta6, Luna Boschetti7, Manila Antonelli4, Paolo Ferroli8, Daniele Bertin9, Emilia Pecori10, Veronica Biassoni7, Maria Luisa Garrè11, Elisabetta Schiavello7, Iacopo Sardi12, Elisabetta Viscardi13, Giovanni Scarzello14, Maurizio Mascarin15, Lucia Quaglietta16, Giuseppe Cinalli17, Lorenzo Genitori18, Paola Peretta19, Anna Mussano20, Salvina Barra21, Angela Mastronuzzi22, Carlo Giussani23, Carlo Efisio Marras24, Rita Balter25, Patrizia Bertolini26, Assunta Tornesello27, Milena La Spina28, Francesca Romana Buttarelli29, Antonio Ruggiero30, Massimo Caldarelli31, Geraldina Poggi32, Lorenza Gandola10. 1. Pediatric Unit (MM, LB, VB, ES), Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy. maura.massimino@istitutotumori.mi.it. 2. Clinical Epidemiology and Trial Organization Unit (FB), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 3. Laboratory of Genetics, Pathology Unit (PM), S. Anna General Hospital, Como, Italy. 4. Department of Radiological, Oncological and Anatomo-Pathological Sciences (FG, MA), Sapienza University, Rome, Italy. 5. IRCCS Neuromed (FG), Pozzuoli, Italy. 6. Neuroradiology (LC, AE), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy. 7. Pediatric Unit (MM, LB, VB, ES), Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy. 8. Neurosurgery Department (PF), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy. 9. Pediatric Onco-Hematology (DB), A.O.U. Città della Salute e della Scienza, Turin, Italy. 10. Pediatric Radiotherapy Unit (LG, EP), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 11. Neurosurgery Unit (MLG), Istituto Giannina Gaslini, Genoa, Italy. 12. Neuro-oncology (IS), Ospedale Pediatrico Meyer, Florence, Italy. 13. Pediatric Oncology Unit, (EV), Padova University, Padua, Italy. 14. Radiotherapy Department (GS), IOV-IRCCS, Padua, Italy. 15. Pediatric Radiotherapy (MaM), CRO, Aviano, Italy. 16. Pediatric Oncology (LQ), Ospedale Santobono-Pausillipon, Naples, Italy. 17. Neurosurgery Unit (GC), Ospedale Santobono-Pausillipon, Naples, Italy. 18. Neurosurgery Unit (LG), Ospedale Pediatrico Meyer, Florence, Italy. 19. Pediatric Neurosurgery Unit (PP), A.O.U. Città della Salute e della Scienza, Turin, Italy. 20. Radiotherapy (AM), A.O.U. Città della Salute e della Scienza, Turin, Italy. 21. Department of Radiation Oncology (SB), IRCCS San Martino IST, Genoa, Italy. 22. Pediatric Hematology and Oncology Unit (AnM), Ospedale Pediatrico Bambino Gesù, Rome, Italy. 23. Neurosurgery Unit (CG), University of Milano-Bicocca, Ospedale San Gerardo, Monza, Italy. 24. Neurosurgery Unit (CEM), Ospedale Pediatrico Bambino Gesù, Rome, Italy. 25. Pediatric Oncology Unit (RB), Ospedale della Donna e del Bambino, Verona, Italy. 26. Pediatric Oncology Unit (PB), University Hospital of Parma, Parma, Italy. 27. Pediatric Oncology Unit (AT), Ospedale Vito Fazzi, Lecce, Italy. 28. Unit of Paediatric Haematology and Oncology (MLS), Hospital Policlinico, University of Catania, Catania, Italy. 29. Neurological Science (FRB), Sapienza University, Rome, Italy. 30. Pediatric Oncology (AR), Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy. 31. Neurosurgery (MC), Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy. 32. Acquired Brain Lesions Unit (GP), IRCCS Eugenio Medea, Bosisio Parini, Italy.
Abstract
PURPOSE: The aims of patients' radiological surveillance are to: ascertain relapse; apply second-line therapy; accrue patients in phase 1/2 protocols if second-line therapy is not standardized/curative; and assess/treat iatrogenic effects. To lessen the emotional and socioeconomic burdens for patients and families, we ideally need to establish whether scheduled radiological surveillance gives patients a better outcome than waiting for symptoms and signs to appear. METHODS: We analyzed a prospective series of 160 newly-diagnosed and treated pediatric/adolescent patients with intracranial ependymoma, comparing patients with recurrent disease identified on scheduled MRI (the RECPT group; 34 cases) with those showing signs/symptoms of recurrent disease (the SYMPPT group; 16 cases). The median follow-up was 67 months. RESULTS: No significant differences emerged between the two groups in terms of gender, age, tumor grade/site, shunting, residual disease, or type of relapse (local, distant, or concomitant). The time to relapse (median 19 months; range 5-104) and the MRI follow-up intervals did not differ between the SYMPPT and RECPT groups. The presence of signs/symptoms was an unfavorable factor for overall survival (OS) after recurrence (5-year OS: 8% vs. 37%, p = 0.001). On multivariable analysis, an adjusted model confirmed a significantly worse OS in the SYMPPT than in the RECPT patients. CONCLUSIONS: Symptomatic relapses carried a significantly worse survival for ependymoma patients than recurrences detected by MRI alone. It would therefore be desirable to identify recurrences before symptoms develop. Radiological follow-up should be retained in ependymoma patient surveillance because there is a chance of salvage treatment for relapses found on MRI.
PURPOSE: The aims of patients' radiological surveillance are to: ascertain relapse; apply second-line therapy; accrue patients in phase 1/2 protocols if second-line therapy is not standardized/curative; and assess/treat iatrogenic effects. To lessen the emotional and socioeconomic burdens for patients and families, we ideally need to establish whether scheduled radiological surveillance gives patients a better outcome than waiting for symptoms and signs to appear. METHODS: We analyzed a prospective series of 160 newly-diagnosed and treated pediatric/adolescent patients with intracranial ependymoma, comparing patients with recurrent disease identified on scheduled MRI (the RECPT group; 34 cases) with those showing signs/symptoms of recurrent disease (the SYMPPT group; 16 cases). The median follow-up was 67 months. RESULTS: No significant differences emerged between the two groups in terms of gender, age, tumor grade/site, shunting, residual disease, or type of relapse (local, distant, or concomitant). The time to relapse (median 19 months; range 5-104) and the MRI follow-up intervals did not differ between the SYMPPT and RECPT groups. The presence of signs/symptoms was an unfavorable factor for overall survival (OS) after recurrence (5-year OS: 8% vs. 37%, p = 0.001). On multivariable analysis, an adjusted model confirmed a significantly worse OS in the SYMPPT than in the RECPT patients. CONCLUSIONS: Symptomatic relapses carried a significantly worse survival for ependymomapatients than recurrences detected by MRI alone. It would therefore be desirable to identify recurrences before symptoms develop. Radiological follow-up should be retained in ependymomapatient surveillance because there is a chance of salvage treatment for relapses found on MRI.
Authors: Reuben Antony; Kenneth E Wong; Moneil Patel; Arthur J Olch; Gordon McComb; Mark Krieger; Floyd Gilles; Richard Sposto; Anat Erdreich-Epstein; Girish Dhall; Sharon Gardner; Jonathan L Finlay Journal: Pediatr Blood Cancer Date: 2014-02-24 Impact factor: 3.167
Authors: C F Torres; S Rebsamen; J H Silber; L N Sutton; L T Bilaniuk; R A Zimmerman; J W Goldwein; P C Phillips; B J Lange Journal: N Engl J Med Date: 1994-03-31 Impact factor: 91.245
Authors: E Bouffet; F Doz; M C Demaille; P Tron; H Roche; D Plantaz; A Thyss; J L Stephan; O Lejars; E Sariban; M Buclon; J M Zücker; M Brunat-Mentigny; J L Bernard; J C Gentet Journal: Br J Cancer Date: 1998-04 Impact factor: 7.640
Authors: Jonas E Adolph; Gudrun Fleischhack; Ruth Mikasch; Julia Zeller; Monika Warmuth-Metz; Brigitte Bison; Martin Mynarek; Stefan Rutkowski; Ulrich Schüller; Katja von Hoff; Denise Obrecht; Torsten Pietsch; Stefan M Pfister; Kristian W Pajtler; Olaf Witt; Hendrik Witt; Rolf-Dieter Kortmann; Beate Timmermann; Jürgen Krauß; Michael C Frühwald; Andreas Faldum; Robert Kwiecien; Udo Bode; Stephan Tippelt Journal: Neuro Oncol Date: 2021-06-01 Impact factor: 12.300