A systematic review of treatment outcomes in pediatric patients with intracranial ependymomas

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Ependymoma is the third most common primary brain tumor in children. Tumors are classified according to the WHO pathological grading system. Prior studies have shown high levels of variability in patient outcomes within and across pathological grades. The authors reviewed the results from the published literature on intracranial ependymomas in children to describe clinical outcomes as they relate to treatment modality, associated mortality, and associated progression-free survival (PFS).</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A search of English language peer-reviewed articles describing patients 18 years of age or younger with intracranial ependymomas yielded data on 182 patients. These patients had undergone treatment for ependymoma with 1 of 5 modalities: 1) gross-total resection (GTR), 2) GTR as well as external beam radiation therapy (EBRT), 3) subtotal resection (STR), 4) STR as well as EBRT, or 5) radiosurgery. Mortality and outcome data were analyzed for time to tumor progression in patients treated with 1 of these 5 treatment modalities.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Of these 182 patients, 69% had supratentorial ependymomas and 31% presented with infratentorial lesions. Regardless of tumor location or pathological grade, STR was associated with the highest rates of mortality. In contrast, GTR was associated with the lowest rates of mortality, the best overall survival, and the longest PFS. Children with WHO Grade II ependymomas had lower mortality rates when treated more aggressively with GTR. However, patients with WHO Grade III tumors had slightly better survival outcomes after a less aggressive surgical debulking (STR+EBRT) when compared with GTR.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Mortality, PFS, and overall survival vary in pediatric patients with intracranial ependymomas. Pathological classification, tumor location, and method of treatment play a role in outcomes. In this study, GTR was associated with the best overall and PFS rates. Patients with WHO Grade II tumors had better overall survival after GTR+EBRT and better PFS after GTR alone. Patients with WHO Grade III tumors had better overall survival after STR+EBRT. Patients with infratentorial tumors had improved overall survival compared with those with supratentorial tumors. Progression-free survival was best in those patients with infratentorial tumors following STR+EBRT. Consideration of all of these factors is important when counseling families on treatment options.</jats:p></jats:sec>

Supratentorial parenchymal ependymomas of children: experience with 14 patients at a single institute

“…GTR (10 of 14 patients in our series) is the optimal therapy for symptomatic supratentorial parenchymal ependymomas (2,3,(5)(6)(7)(8)(9)12,15,(18)(19)(20)(21)23). In the present series, the postoperative care of patients depended on the operative procedure.…”

“…Most intracranial ependymomas develop within the ventricular system, but they may arise from the extraventricular parenchyma as well (2)(3)(4)(5)16). Supratentorial parenchymal ependymomas in children are a rarely seen pathological diagnosis.…”

“…These tumors are categorized into myxopapillary (WHO Grade I), ependymoma (WHO Grade II) and anaplastic ependymoma (WHO Grade III). The WHO Grade I tumors are benign and are thought of as a separate clinical and pathological entity (2). The histological criteria of the WHO Grade II ependymomas include infrequent or absent mitoses, occasional nonpalisading foci of necrosis and nodules with better cellularity.…”

“…Supratentorial parenchymal ependymomas represent a subgroup of tumors with a comparatively better prognosis (71.4% of the patients had an excellent outcome postoperatively) than that of infratentorial ependymomas (2,3,5,7,9,13,15). This may be related to the fact that total resection is more commonly achieved in patients with supratentorial tumors.…”

Anaplastic Ependymomas, Report of 3 Pediatric Cases. Update on Molecular Markers - Risk Groups and Therapeutic Options

“…When surgery does not achieve complete resection of the tumor as happened in 2 of the 3 cases, it is proposed to plan a second intervention and offer complementary schemes with radiotherapy, it is the therapeutic option with evidence of better results compared to chemotherapy [7,[9][10][11][12][13]. Early administration of post-surgery radiotherapy versus delayed tumor progression has shown improved survival and progression-free survival [12,13].…”