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Prognostic factors in childhood ependymomas
L N Sutton1, J Goldwein, G Perilongo
1Neuro-oncology program, Children's Hospital of Philadelphia, Pa.
Pediatric Neurosurgery
|January 1, 1990
Summary
Aggressive surgical resection significantly improves outcomes for children with intracranial ependymoma. Adjuvant chemotherapy with CCNU, vincristine, and cisplatinum did not enhance progression-free survival in this patient group.
Area of Science:
- Pediatric Oncology
- Neurosurgery
- Radiation Oncology
Background:
- Intracranial ependymomas are a significant cause of brain tumors in children.
- Treatment strategies have evolved, incorporating surgery, radiation, and chemotherapy.
Purpose of the Study:
- To evaluate the impact of aggressive surgical resection, radiation therapy, and adjuvant chemotherapy on progression-free survival in pediatric intracranial ependymoma.
Main Methods:
- Retrospective analysis of 45 children diagnosed with intracranial ependymoma between 1975 and 1989.
- Treatment included aggressive surgical resection, radiation therapy (involved-field or craniospinal axis), and adjuvant chemotherapy (CCNU, vincristine, cisplatinum) from 1983 onwards.
- Outcome assessment based on 5-year progression-free survival (PFS).
Main Results:
- Operative mortality was 8.8%. The 5-year PFS for 41 patients was 36%.
- Extent of surgical resection was a major determinant of outcome: 5-year PFS was 60% for total/near-total resections versus 21% for partial resections/biopsies (p<0.01).
- Tumor location and histologic grade did not significantly impact survival. Adjuvant chemotherapy did not improve PFS.
Conclusions:
- Aggressive surgical resection is the most critical factor influencing outcomes in childhood intracranial ependymoma.
- Current adjuvant chemotherapy regimens (CCNU, vincristine, cisplatinum) do not improve progression-free survival for this disease.
- Further research into novel therapeutic strategies is warranted.