INTRODUCTION 1/3 of Ependymoma patients will develop recurrence with only 25% are long term survivors. Treatment is usually between surgery, radiotherapy or combinations. PATIENTS AND METHODS Retrospective review of children with recurrent Ependymoma in northwest of Egypt between 2005 and 2019 in Alexandria School of medicine records. RESULTS 27 patients were identified 19 of them after 2010. The median age is 9.7 years (1.5–19), with 16 males and 11 females. Pathology were 11 grade II Ependymoma and 16 anaplastic Ependymoma. 16 had gross residual disease after 1st surgery and 22 received radiotherapy initially at median dose of 53.5 Gy, 4 patients received suboptimal radiotherapy. The initial site was14 supratentorial tumors and 13 infratentorial. Median time to recurrence is 27.6 months(3–84), and recurrences were 17 local and 9 CSF disseminated, and one patient had recurrence at the scar with lung metastasis. At a median follow up of 56.6 months 14(51.8%) are still alive. Treatment was surgery only in 6(4 alive) radiotherapy alone in 2(1alive), combined in 15(9 alive) and 4 patients received neither. The best outcome were in patients with late local relapse treated with complete resection and CSI after 2010. Radiotherapy dose was between 54 to 57.3 Gy and one patient developed reirradiation injury at brain stem. 5 of the 14 living patients is having toxicity in form of hearing aids (4) and low TSH(1). CONCLUSION Aggressive treatment of recurrent Ependymoma with surgery and radiotherapy is feasible and about half of the patients are salvageable.
BACKGROUND: The management of childhood central nervous system (CNS) tumors is complex and often faces numerous challenges in low- and middle- income countries (LMICs), including delayed diagnosis and limited treatment resources. Twinning initiatives between LMICs with high- income countries are feasible and proven to be highly effective at exchanging skills and expertise to improve diagnosis, treatment and care for children with brain tumors. METHODS: A monthly multidisciplinary international pediatric neuro-oncology tumor board via zoom videoconferencing was established in January 2021. This effort is a collaboration between Washington University School of Medicine, in St. Louis, Missouri, USA and nine international sites. Given the significant contributions of this international effort, it has since grown to include 20 institutions and cancer centers from 12 countries in the Middle East, Europe, Australia and South America. RESULTS: As of January 2022, we have held 11 tumor boards, 35 cases were reviewed, and have had 320 experts attend from several specialties – neuro-oncology, neurology, neurosurgery, neuroradiology and neuropathology. A multidisciplinary team of physicians reviewed each case and recommendations were given accordingly. We also started a quarterly neurofibromatosis (NF) meeting focused to leverage the expertise of dedicated specialists in the NF center. Two NF-focused meetings took place since establishing the program, and total of five cases were discussed. CONCLUSION: Virtual videoconferencing promotes a multi-disciplinary approach for the management of pediatric CNS tumors, and it allows access for medical expertise. We anticipate the current initiative will also provide a platform for future international research collaborations and deliver the optimal medical care for neuro-oncology patients globally. Multiple potential collaborative projects are currently underway.
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