Outcomes after re-irradiation for recurrent pediatric intracranial ependymoma
Menée à partir de données portant sur 101 patients pédiatriques atteints d'un épendymome intracrânien ayant récidivé après une radiothérapie (âge : inférieur ou égal à 21 ans), cette étude évalue l'efficacité, du point de vue de la survie globale, et la toxicité d'une seconde irradiation par radiothérapie fractionnée
Purpose : Re-irradiation for recurrent pediatric ependymoma is feasible and safe, but the long-term outcomes and the optimal dose and volume for re-treatment are unknown. Methods and Materials : Patients with recurrent ependymoma treated with a second course of fractionated radiotherapy (RT2) were reviewed retrospectively. Eligible patients had localized, intracranial ependymoma at initial diagnosis that was treated with focal radiation (RT1) without craniospinal irradiation (CSI-RT1), and were aged ≤21 years at the time of RT2. The median doses of RT1, focal RT2, and CSI-RT2 were 59.4, 54, and 39.6 Gy, respectively. The primary endpoint, overall survival (OS), was measured from the first day of RT2. Results : We included 101 patients in the study. The median interval between RT1 and RT2 was 26.8 months (interquartile range [IQR] 18.0–43.1). The median durations of OS and freedom from progression (FFP) were 75.1 and 27.3 months, respectively. Male sex and anaplastic histology at recurrence were associated with decreased OS and FFP on multivariate analysis. Distant-only failure treated with CSI-RT2 was independently associated with improved OS compared to individuals with local failure treated with focal RT2 (HR 0.37, 95% CI 0.16–0.87). Among individuals experiencing any distant failure after RT1, gain of chromosome 1q was adversely associated with poorer OS (HR 3.5, 95% CI 1.1–10.6). No distant-only failures were observed in individuals with RT1 local failure who received CSI-RT2 (n = 10). The 10-year cumulative incidence of grade ≥3 radiation necrosis after RT2 was 7.9%. Conclusions : Re-irradiation for relapsed pediatric ependymoma was well tolerated by most patients and resulted in long-term survival in a subset of patients. The best results were observed in patients who experienced distant-only failure after RT1 and were treated with CSI as part of RT2, without anaplasia at recurrence. The option of re-irradiation should be discussed with patients who develop recurrent ependymoma.
http://www.redjournal.org/article/S0360-3016(17)33963-9/fulltext 2017