Imaging biomarkers of outcome after radiotherapy for pediatric ependymoma

Tensaouti, F.; Ducassou, A.; Chaltiel, Léonor; Sévely, A; Bolle, Stéphanie; Padovani, Laëtitia; Jouin, A.; Alapetite, Claire; Supiot, S.; Huchet, A.; Bernier, V.; Claude, L.; Kerr, Christine; Prisé, É. Le; Bertozzi-Salamon, Anne-Isabelle; Liceaga, S.; Lotterie, Jean Albert; Péran, Patrice; Laprie, Anne

doi:10.1016/j.radonc.2018.02.008

Cited by 6 publications

(3 citation statements)

References 18 publications

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“…We are not suggesting that SIB should substitute second-look surgery in the case of residue, but it should be seriously considered in the case of unresectable residue or FLAIR abnormalities in post-operative imaging (17). Therefore, we think that one promising avenue would be the careful stratification of the population eligible to undergo the dose increase, based on residue presence (18), advanced imaging factors (17, 37), and molecular biology (38).…”

Section: Discussionmentioning

confidence: 99%

“…It is only used in very young patients to avoid irradiation and in children with residual disease after initial resection (15), although it is currently being assessed in the SIOP trial as a maintenance treatment. Based on a large national cohort study (16, 17), our team and others found that the majority of relapses occur within the high-dose regions (10, 16). Moreover, a survival benefit of stereotactic radiotherapy (SRT) to residue was described in a prospective clinical trial (18).…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of Dose Escalation in Patients With Intracranial Pediatric Ependymoma

et al. 2019

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Background and purpose: Pediatric ependymoma carries a dismal prognosis, mainly owing to local relapse within RT fields. The current prospective European approach is to increase the radiation dose with a sequential hypofractionated stereotactic boost. In this study, we assessed the possibility of using a simultaneous integrated boost (SIB), comparing VMAT vs. IMPT dose delivery. Material and methods: The cohort included 101 patients. The dose to planning target volume (PTV59.4) was 59.4/1.8 Gy, and the dose to SIB volume (PTV67.6) was 67.6/2.05 Gy. Gross tumor volume (GTV) was defined as the tumor bed plus residual tumor, clinical target volume (CTV59.4) was GTV + 5 mm, and PTV59.4 was CTV59.4 + 3 mm. PTV67.6 was GTV+ 3 mm. After treatment plan optimization, quality indices and doses to target volume and organs at risk (OARs) were extracted and compared with the standard radiation doses that were actually delivered (median = 59.4 Gy [50.4 59.4]). Results: In most cases, the proton treatment resulted in higher quality indices ( p < 0.001). Compared with the doses that were initially delivered, mean, and maximum doses to some OARs were no higher with SIB VMAT, and significantly lower with protons ( p < 0.001). In the case of posterior fossa tumor, there was a lower dose to the brainstem with protons, in terms of V59 Gy, mean, and near-maximum (D2%) doses. Conclusion: Dose escalation with intensity-modulated proton or photon SIB is feasible in some patients. This approach could be considered for children with unresectable residue or post-operative FLAIR abnormalities, particularly if they have supratentorial tumors. It should not be considered for infratentorial tumors encasing the brainstem or extending to the medulla.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Feasibility of Dose Escalation in Patients With Intracranial Pediatric Ependymoma

et al. 2019

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“… 17 , 18 Additionally, a better understanding of MRI suggests new predictive markers for tumor recurrence. 19 …”

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confidence: 99%

Evaluation of dose, volume, and outcome in children with localized, intracranial ependymoma treated with proton therapy within the prospective KiProReg Study

et al. 2021

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Purpose Radiotherapy (RT) of ependymoma in children is an important part of the interdisciplinary treatment concept. However, feasibility and dose concepts are still under investigation, particularly in very young children. The aim of this study was to evaluate standard dose and volume of proton therapy (PT) in children with ependymoma. Material and Methods In this analysis, 105 patients with localized, intracranial ependymoma under the age of 18 years treated with PT between 2013 and 2018 were included. Patient characteristics, treatment, outcome and follow-up data were analyzed using descriptive statistics, Kaplan-Meier and Cox regression analysis. Results The median age of patients at PT was 2.8 years (0.9-17.0 years). The molecular subgroup analysis was performed in a subset of 50 patients (37 EP-PFA, 2 EP-PFB, 7 EP-RELA, 2 EP-YAP, 2 NEC (not elsewhere classified)). The median total dose was 59.4 Gy (54.0-62.0 Gy). The median follow-up time was 1.9 years. The estimated 3-year overall survival (OS), local control (LC) and progression-free survival (PFS) rate were 93.7 %, 74.1 % and 55.6 %, respectively. Within univariable analysis female gender and lower dose had a positive impact on OS, whereas age ≥ 4 years had a negative impact on OS and PT given after progression had a negative impact on PFS. In the multivariable analysis multiple tumor surgeries were associated with lower PFS. New ≥ 3° late toxiscities occurred in 11 patients. Conclusion For children with localized ependymoma, PT was effective and well tolerable. Multiple surgeries showed negative impact on PFS.

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Apport du guidage par l’image pour le repositionnement au cours de la radiothérapie des tumeurs encéphaliques

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Padovani

Claude

et al. 2018

Cancer/Radiothérapie

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Imaging biomarkers of outcome after radiotherapy for pediatric ependymoma

Cited by 6 publications

References 18 publications

Feasibility of Dose Escalation in Patients With Intracranial Pediatric Ependymoma

Feasibility of Dose Escalation in Patients With Intracranial Pediatric Ependymoma

Evaluation of dose, volume, and outcome in children with localized, intracranial ependymoma treated with proton therapy within the prospective KiProReg Study

Apport du guidage par l’image pour le repositionnement au cours de la radiothérapie des tumeurs encéphaliques

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