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[Intracranial ependymoma in children. Prognosis and therapeutic perspectives]
Insights
This study on pediatric intracranial ependymomas found that 14.5% of cases developed intraspinal metastases, primarily in infratentorial tumors. A tailored radiotherapy protocol is recommended, including the craniospinal axis for infratentorial ependymomas.
Area of Science:
- Pediatric neurosurgery
- Pediatric oncology
- Radiation oncology
Context:
- Intracranial ependymomas are a significant cause of brain tumors in children.
- Understanding metastasis patterns is crucial for effective treatment planning.
- Previous studies have varied in their findings regarding intraspinal spread.
Purpose:
- To determine the incidence of intraspinal metastases in pediatric intracranial ependymomas.
- To propose an optimized postoperative radiotherapy protocol.
- To analyze survival rates and recurrence patterns in this patient cohort.
Summary:
- A retrospective analysis of 47 pediatric intracranial ependymoma cases (1969-1979) revealed a 17% operative mortality and a 5-year survival rate of 51% post-surgery.
- Recurrence was observed in 41% of cases, with overall metastases in 20%. Intraspinal metastases occurred in 14.5%, exclusively in infratentorial ependymomas (both benign and malignant).
- The findings suggest a need for radiotherapy protocols adjusted for tumor location and histological grade, advocating for whole craniospinal axis irradiation in infratentorial ependymomas.
Impact:
- Highlights the specific risk of intraspinal metastasis in infratentorial ependymomas.
- Provides evidence to support tailored radiotherapy strategies for pediatric ependymomas.
- Informs clinical decision-making for optimizing treatment and improving outcomes in pediatric brain tumor patients.
Abstract:
The authors report 47 cases of intracranial ependymomas occurring in children less than 15 years of age, who were operated on from 1969 to 1979. The aim of the study was to study the incidence of intraspinal metastases and to suggest a logical protocol for postoperative radiotherapy. The operative mortality rate was 17%. The 5 year survival rate, after exclusion of postoperative mortality, was 51%. Recurrences developed in 41% of cases and metastases in 20%. Among these, intraspinal metastases occurred in 14.5% and were found only in infratentorial ependymomas, whether benign or malignant. The results and those in the literature suggest that a protocol of irradiation adapted to the site and the histological grading of these tumors should be discussed with the teams of radiotherapy; in infratentorial ependymomas, the irradiation should include the whole craniospinal axis.