Conformal Radiation Therapy for Ependymoma Age < 3 years: 25 Year Experience
Menée sur la période 1997-2018 auprès de 101 patients pédiatriques atteints d'un épendymome intracrânien (durée médiane de suivi : 18,4 ans), cette étude analyse la survie globale et sans événement lors d'un traitement par photonthérapie conformationnelle avec modulation d'intensité après une chirurgie définitive
Background: Adjuvant radiotherapy (RT) impacts survival after surgery for young children (age < 3 years) diagnosed with intracranial ependymoma. Conformal photon RT promised to spare normal tissue and was introduced more than 25 years ago to improve outcomes for these vulnerable patients. Long-term results for those first treated with conformal methods provide valuable information and serve as a comparison against newer methods. Methods: Between 1997 and 2018, 101 patients were treated when age < 3.1 years with conformal and intensity-modulated photon therapy after definitive surgery for intracranial ependymoma. The median time age at RT was 2.1 years and the time from diagnosis to RT start 10 weeks. The extent of resection was gross-total in 82% and 38% underwent more than one attempt at resection. The total prescribed dose was 54-59.4 Gy at 1.8 Gy per fraction. Results: The 10-year event-free and overall survivals were 58.5% ± 5.0% and 72.6% ± 4.5%, respectively, with a median follow-up of 18.4 years (range, 4.2-23.3 years). Tumor progression occurred in 34 patients with a median time of 1.6 years. Death occurred in 34 patients from ependymoma (n=24), secondary malignancy (n=6), necrosis (n=2), shunt failure (n=1), and anaphylactic reaction (n=1). Twenty-three patients developed a secondary tumor including 6 cases of fatal high-grade glioma. Of the surviving cohort and those age 18 years or older, 98% obtained a high school diploma, 64% had a current driver's license, 89% were students or employed full or part time, 32% were living independently, and 70% received higher education or training. Conclusion: Long-term results of children treated using photon conformal radiation therapy after surgery demonstrate that adjuvant RT resulted in long-term disease control and functional independence. These results point to the need for new treatment strategies to improve tumor control and provide investigators hope that newer RT methods will further reduce complications.
International Journal of Radiation Oncology, Biology, Physics 2023