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Reirradiation for Patients With Recurrent Ependymoma Across the Age Spectrum
Ying Ying Sum1,2, Julie Bennett2,3, Vijay Ramaswamy2
1Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
Purpose:
In patients with locally recurrent ependymoma, previous data have shown that repeat radiation therapy (RT2) with craniospinal irradiation (CSI) improves disease control compared with focal RT2 alone. This study aimed to report long-term outcomes of adults and children with recurrent intracranial ependymoma, including those treated with CSI.
Methods And Materials:
In this retrospective, single-institution study, we identified 48 patients treated with RT2 for recurrent ependymoma between 1999 and 2024. The primary endpoint was overall survival (OS) with the start of RT2 as the index time. CSI was prescribed to 23.4 or 36 Gy, followed by focal boost radiation therapy to 54 Gy. OS was estimated using the Kaplan-Meier method; groups were compared using the log-rank test.
Results:
The median age at initial diagnosis was 6.5 years (range, 0.8-62.3 years), and the majority of patients were pediatric (83%; aged <18 years) with a posterior fossa (PF) tumor location (67%). Of the 35 patients with available molecular pathology, 23 had PF-A, and 11 had a zinc finger translocation associated fusion. The median follow-up was 9.1 years. Gross total resection of all disease prior to RT2 was associated with better 5-year OS (57% vs 19%; P = .015). Among the 33 patients (69%) with only local recurrence, the 5-year OS was significantly higher with CSI-RT2 (n = 10) than with focal RT2 (n = 23) (78% vs 36%, respectively; P = .040). In the subgroup of 24 PF local recurrences, the 5-year OS was 83% with CSI (n = 7) and 30% with focal RT2 (n = 17) (P = .061). The 5-year OS for the 15 patients with disseminated-only or synchronous local and disseminated failures was 20%; all but 1 were treated with CSI-RT2.
Conclusions:
In this single-institution cohort of patients with recurrent ependymoma and long-term follow-up, gross total resection of recurrence was associated with better survival, and locally recurrent patients treated with CSI-RT2 had longer OS. Further work is required to determine the independent effects of CSI-RT2 together with the extent of re-resection.
