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Second-look surgery for ependymoma: the Italian experience
Maura Massimino1, Carlo Lazzaro Solero, Maria Luisa Garrè
1Pediatric Unit, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale Tumori, Milano, Italy. maura.massimino@istitutotumori.mi.it
Journal of Neurosurgery. Pediatrics
|September 3, 2011
Summary
Second-look surgery for pediatric ependymoma is a safe and effective strategy to achieve complete tumor removal. This approach, sometimes combined with chemotherapy, offers comparable outcomes to single surgeries, improving patient prognosis.
Area of Science:
- Pediatric neurosurgery
- Pediatric oncology
- Neoadjuvant chemotherapy
Background:
- Complete resection of pediatric ependymoma improves prognosis.
- Infratentorial ependymoma resection carries significant risks.
- Second-look surgery may offer a safer alternative for complete tumor removal.
Purpose of the Study:
- To evaluate the feasibility and outcomes of second-look surgery for pediatric intracranial ependymoma.
- To assess the role of neoadjuvant chemotherapy in preparation for further surgical resection.
- To compare outcomes of single versus multiple resections for ependymoma.
Main Methods:
- Two successive protocols for intracranial ependymoma treatment were analyzed.
- Protocols included adjuvant chemotherapy and planned second-look surgery for residual tumor.
- Patient outcomes were compared based on the number of surgical resections.
Main Results:
- Second-look surgery was performed in 9/63 children (Protocol 1) and 29/110 (Protocol 2).
- In Protocol 2, reoperations occurred after initial surgery, chemotherapy, or radiotherapy.
- Outcomes, including progression-free and overall survival, were comparable between single and multiple resections.
Conclusions:
- Second-look surgery is feasible with low morbidity for pediatric ependymoma.
- Results improved over time with protocol refinement.
- Local tumor control is achievable with one or more resections.
