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Prognostic factors and treatment options for paediatric ependymomas
K Vaidya1, R Smee, Janet R Williams
1Department of Radiation Oncology, The Prince of Wales Cancer Centre, Level 2, High Street, Randwick, New South Wales 2031, Australi.
Insights
Pediatric ependymoma prognosis is better with supratentorial tumors and aggressive radiotherapy (>50 Gy). Complete resection and avoiding recurrence are key for improved survival in pediatric ependymoma patients.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Radiation Oncology
Background:
- Ependymomas are common primary brain tumors in children.
- Accurate prognostic factors and effective treatment strategies are crucial for improving outcomes in pediatric ependymoma patients.
Purpose of the Study:
- To identify prognostic factors for pediatric ependymomas.
- To evaluate the efficacy of different treatment modalities for pediatric ependymoma.
Main Methods:
- Retrospective study of 43 pediatric ependymoma patients treated between 1969-2009.
- Statistical analysis of overall survival (OS) and progression-free survival (PFS) based on tumor location, treatment, and recurrence.
Main Results:
- Five-year OS and PFS rates were 50.3% and 44.8%, respectively.
- Supratentorial tumors, stereotactic radiotherapy, and radiotherapy doses >50 Gy were associated with better OS and PFS.
- Tumor recurrence significantly worsened prognosis.
Conclusions:
- Aggressive treatment, including maximal surgical resection and adjuvant radiotherapy (>50 Gy), is recommended for infratentorial and recurrent ependymomas.
- Complete surgical resection and avoiding recurrence are critical for favorable outcomes in pediatric ependymoma.
Abstract:
The aim of this study was to determine factors of prognostic relevance for paediatric ependymomas, and evaluate the efficacy of treatment modalities. This is a retrospective study of 43 patients with ependymoma (<18 years) who underwent a combination of surgical excision, chemotherapy, and/or radiotherapy treatment at The Prince of Wales Cancer Centre between 1969 and 2009. Statistical analysis was performed to assess the prognostic relevance of various parameters affecting the two-year and five-year overall survival (OS) and progression-free survival (PFS). The five-year OS and PFS were 50.3% and 44.8% respectively (median follow-up 50 months). Eighteen patients (41.9%) experienced tumour recurrence: 13 had a local recurrence (LR) and five had both LR and distant recurrence. On univariate analysis, a more favourable prognosis in terms of both OS and PFS was evident for supratentorial tumours compared to infratentorial tumours (OS p=0.007, PFS p=0.045), stereotactic radiosurgery/ fractionated stereotactic radiotherapy compared to craniospinal irradiation or local posterior fossa/local brain±boost radiotherapy modalities (OS p=0.047, PFS p=0.031), total radiotherapy dose >50 Gy compared to ≤50 Gy (OS p=0.008, PFS p=0.005), and in patients with no tumour recurrence compared to those with recurrence (OS p=0.03, PFS p<0.001). Although not statistically significant, a more favourable multivariate outcome was evident in patients who underwent complete surgical resection. Chemotherapy treatment and histopathological grade, however, were not relevant to prognosis. This study supports the need to pursue more aggressive treatment for infratentorial and/or recurrent tumours. Ideal treatment involves maximal surgical resection, followed by adjuvant radiotherapy (>50 Gy).
