Primary postoperative chemotherapy without radiotherapy for intracranial ependymoma in children: the UKCCSG/SIOP prospective study

Grundy, Richard G.; Wilne, Sophie; Weston, Claire; Robinson, Kath; Lashford, L. S.; Ironside, James W.; Cox, Tim; Chong, WK; Campbell, R. H. A.; Bailey, C C; Gattamaneni, Rao; Picton, Sue; Thorpe, Nicky; Mallucci, Conor; English, Martin; Punt, Jonathan; Walker, David; Ellison, David W.; Machin, David

doi:10.1016/s1470-2045(07)70208-5

Cited by 225 publications

(164 citation statements)

References 39 publications

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“…The authors reported a 3-year PFS of 69.5%, but 34 of 50 patients who had evidence of progression underwent subsequently radiotherapy. 159 These findings are better than prior reports from the POG, who treated patients from 1986 until 1990 with 12 or 24 months of chemotherapy prior to radiation with a disappointing 5-year PFS of 27%. 160 The French oncology group reported a 4-year PFS of 22% in 73 patients treated with chemotherapy only.…”

Section: Chemotherapymentioning

confidence: 68%

Pediatric Brain Tumors: Current Treatment Strategies and Future Therapeutic Approaches

2009

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Summary:Pediatric CNS tumors are the most common solid tumors of childhood and the second most common cancer after hematological malignancies accounting for approximate 20 to 25% of all primary pediatric tumors. With over 3,000 new cases per year in the United States, childhood CNS tumors are the leading cause of death related to cancer in this population. The prognosis for these patients has improved over the last few decades, but current therapies continue to carry a high risk of significant side effects, especially for the very young. Currently a combination of surgery, radiation, and chemotherapy is often used in children greater than 3 years of age. This article will outline current and future therapeutic strategies for the most common pediatric CNS tumors, including primitive neuroectodermal tumors such as medulloblastoma, as well as astrocytomas and ependymomas.

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Section: Chemotherapymentioning

confidence: 68%

Pediatric Brain Tumors: Current Treatment Strategies and Future Therapeutic Approaches

2009

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“…Historically, children below 3 years of age and infratentorial ependymomas have been associated with a poor outcome (6,(22)(23)(24). It remains unclear whether this reflects tumor biology, the surgical inaccessibility of posterior fossa tumors, which are more prevalent in younger children, or the avoidance of adjuvant radiotherapy in early life resulting from concerns about long term clinical sequelae (4,14,23,25,26).…”

Section: Introductionmentioning

confidence: 99%

Pediatric Ependymoma: Biological Perspectives

Kilday

Rahman

Dyer

et al. 2009

Molecular Cancer Research

167

204

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Pediatric ependymomas are enigmatic tumors that continue to present a clinical management challenge despite advances in neurosurgery, neuroimaging techniques, and radiation therapy. Difficulty in predicting tumor behavior from clinical and histological factors has shifted the focus to the molecular and cellular biology of ependymoma in order to identify new correlates of disease outcome and novel therapeutic targets. This article reviews our current understanding of pediatric ependymoma biology and includes a meta-analysis of all comparative genomic hybridization (CGH) studies done on primary ependymomas to date, examining more than 300 tumors. From this meta-analysis and a review of the literature, we show that ependymomas in children exhibit a different genomic profile to those in adults and reinforce the evidence that ependymomas from different locations within the central nervous system (CNS) are distinguishable at a genomic level. Potential biological markers of prognosis in pediatric ependymoma are assessed and the ependymoma cancer stem cell hypothesis is highlighted with respect to tumor resistance and recurrence. We also discuss the shifting paradigm for treatment modalities in ependymoma that target molecular alterations in tumor-initiating cell populations. (Mol Cancer Res 2009;7(6):765-86)

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“…A North American Childrens Cancer Group randomized trial in the 1980s (CCG-942) that evaluated adjuvant chemotherapy with lomustine, vincristine, and prednisone after surgery and irradiation failed to show any difference in OS when compared to irradiation alone; craniospinal irradiation (36Gy) with primary site boost (54 Gy) was administered to all patients [20]. The studies undertaken to delay chemotherapy in young children have generally shown poor success rates [9,[21][22][23].…”

Section: Discussionmentioning

confidence: 99%

Supratentorial ependymoma in children: To observe or to treat following gross total resection?

Venkatramani

Dhall

Patel

et al. 2011

Pediatric Blood & Cancer

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BackgroundThe standard treatment for ependymoma is surgical resection followed by postoperative irradiation to the local site. The role of radiation therapy in completely resected supratentorial ependymoma has been questioned over the past two decades.ProcedureRetrospective review of the medical records of all consecutively diagnosed supratentorial ependymoma patients at Children's Hospital Los Angeles between January 1999 and December 2009.ResultsTen patients (three females) were included. The median age at presentation was 5.6 years (range 1.8–15.6 years). Reviewed histology was anaplastic ependymoma in seven patients and cellular ependymoma in three patients. Gross total resection was achieved in six patients; five were observed and one received chemotherapy. In the four patients who underwent subtotal resection, one was observed, two received local irradiation and one received irradiation and chemotherapy. The median length of follow up was 43 (range 22–81) months. Four relapses were observed; two patients who underwent initial gross total resection. All patients who underwent gross total resection were alive at the time of preparation of this article. The 5‐year progression‐free and overall survival rates were 53 ± 19% and 86 ± 13% respectively.ConclusionsRadiation therapy was avoided in five patients following gross total resection, four of whom had anaplastic histology. In some children with completely resected supratentorial ependymoma, surgery alone may be an acceptable treatment option. Pediatr Blood Cancer 2012; 58: 380–383. © 2011 Wiley Periodicals, Inc.

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Primary postoperative chemotherapy without radiotherapy for intracranial ependymoma in children: the UKCCSG/SIOP prospective study

Cited by 225 publications

References 39 publications

Pediatric Brain Tumors: Current Treatment Strategies and Future Therapeutic Approaches

Pediatric Brain Tumors: Current Treatment Strategies and Future Therapeutic Approaches

Pediatric Ependymoma: Biological Perspectives

Supratentorial ependymoma in children: To observe or to treat following gross total resection?

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