Stereotactic Radiosurgery for Intracranial Ependymomas: An International Multicenter Study

Kano, Hideyuki; Su, Yan-Hua; Wu, Hsiu‐Mei; Šimonová, Gabriela; Cohen-Inbar, Or; Sheehan, Jason P.; Meola, Antonio; Sharma, Mayur; Barnett, Gene H.; Mathieu, David; Vasas, Lucas T; Kaufmann, Anthony M.; Jacobs, Rachel; Lunsford, L. Dade

doi:10.1093/neuros/nyy082

Cited by 17 publications

(20 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…With most of the available SRS and SBRT data for ependymomas focusing on intracranial lesions, outcome data for spinal treatments remain sparse ( 10 – 12 , 15 – 18 ). Moreover, the majority of previous studies on SRS utilized GammaKnife (GK)- or conventional linear accelerator (LINAC)-based radiosurgery ( 11 , 12 , 15 – 17 , 19 – 21 ). Previous studies analyzing SRS and SBRT for intracranial and spinal ependymal tumors observed LC rates typically ranging between 60 and 80% ( 10 , 13 , 15 , 16 , 19 – 22 ).…”

Section: Discussionmentioning

confidence: 99%

“…Given the recent identification of these genetic parameters and the rarity of the tumor, large prospective validations are lacking ( 1 , 6 , 7 ). Previous studies identified differing predictors of OS and progression-free survival (PFS), including the extent of first surgical resection, WHO grade III, intracranial tumor location as well as age, gender and tumor volume at the time of reirradiation ( 11 , 27 , 28 ). Our study cohort mainly consisted of adult patients (83%), with most of them suffering from a primary spinal ependymoma (75%).…”

Section: Discussionmentioning

confidence: 99%

“…In patients with poor Karnofsky Performance Status (KPS), tumor relapses, widespread disease, and multiple spinal lesions, surgery and conventional radiotherapy may not be repeatable or feasible ( 1 , 2 ). Stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) may be salvage treatment options and help to stop local tumor progression - at least temporarily ( 9 – 11 ). Information on the treatment outcomes after SRS and SBRT for ependymal tumor lesions are scarce, especially concerning spinal ependymomas and robotic radiosurgery (RRS) ( 10 , 12 , 13 ).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Image-Guided Robotic Radiosurgery for the Management of Spinal Ependymomas

Ehret

Kufeld²,

Fürweger³

et al. 2021

Front. Oncol.

View full text Add to dashboard Cite

BackgroundEpendymomas are rare neoplasms of the central nervous system (CNS), usually localized intracranially and most commonly diagnosed in children. Spinal ependymomas are more frequent in young adults. They are either primary lesions or manifest as disseminated seeding of cranial tumors. Data on the management of spinal ependymoma lesions remain scarce, especially concerning stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT). The purpose of this study is to report the treatment outcomes of two institutions using robotic radiosurgery (RRS) for the treatment of spinal ependymomas.Materials and MethodsAll patients with a histopathologically confirmed diagnosis of an ependymoma WHO grade II or III who were treated with RRS for one or more spinal lesions were included in this analysis.ResultsTwelve patients underwent RRS for the treatment of 32 spinal ependymoma lesions between 2005 and 2020. Two patients were below the age of 18 when treated, whereas nine patients (75%) suffered from a primary spinal ependymoma. The median dose was 15 Gy prescribed to a median isodose of 70%, with 27 lesions (84%) receiving a single-session treatment. The local control (LC) after a median follow-up of 56.7 months was 84%. LC rates at 1, 3, and 5 years were 92, 85, and 77%, respectively. The Kaplan-Meier estimated overall survival after 1, 3, and 5 years were 75, 75, and 64%, respectively. Five patients died, all of them suffering from an anaplastic ependymoma, with widespread CNS tumor progression being the reason for death in four patients. The majority of patients (58%) showed a stable neurological status at the last available follow-up. Overall, the treatment was well tolerated.ConclusionRRS appears to be a safe and efficient treatment modality for managing primary and secondary spinal ependymal tumors in patients with multiple lesions and local recurrences.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Image-Guided Robotic Radiosurgery for the Management of Spinal Ependymomas

Ehret

Kufeld²,

Fürweger³

et al. 2021

Front. Oncol.

View full text Add to dashboard Cite

show abstract

“…This marginal advantage of combined plans over VMAT plans should be weighed against the more complex and costly course of CyberKnife plans, and should be investigated in large clinical trials to prove its clinical benefit. Variable studies discussed the use of stereotactic radiosurgery and fractionated stereotactic radiotherapy in ependymoma cases [25][26][27] . Kano and colleagues reported the results of salvaging recurrent/residual ependymoma cases post-surgical excision and RT using stereotactic radiosurgery 25 .…”

Section: Discussionmentioning

confidence: 99%

“…Variable studies discussed the use of stereotactic radiosurgery and fractionated stereotactic radiotherapy in ependymoma cases [25][26][27] . Kano and colleagues reported the results of salvaging recurrent/residual ependymoma cases post-surgical excision and RT using stereotactic radiosurgery 25 . In their analysis, the 5-year OS rate for pediatric patients was 38.5% and patients with age < 18 years had significantly worse local control rate compared to older patients (p=0.014).…”

Section: Discussionmentioning

confidence: 99%

CyberKnife Boost in Pediatric Ependymoma of the Fourth Ventricle

Mousa

Khafaga

ElBeltagi

et al. 2020

Kasr-Al-Aini J.of Clin. Onc. and Nuc. Med.

View full text Add to dashboard Cite

Background: Ependymoma of the fourth ventricle is a challenging disease. Brain stem tolerance dose usually hinders the delivery of adequate radiation dose to target volumes. Aim: To present the treatment outcome of pediatric ependymoma of the fourth ventricle using combined CyberKnife and volumetric modulated arc therapy (VMAT) and compare it to VMAT plans. Methods: The medical charts of 15 patients were retrospectively reviewed. All patients underwent surgery and received radiotherapy in 2 phases using combined plans of VMAT and CyberKnife boost aiming for a total prescription dose of 59.4 Gy in 33 fractions. These plans were compared to a cone-down two-phase VMAT plans. At least 95% of the target volume was required to be encompassed by the 95% isodose level of prescription dose. Results: It was not feasible to achieve adequate target coverage using VMAT without exceeding the brain stem tolerance doses in all but one case. Brain stem maximum point dose, V59 Gy, V55.8 Gy and mean doses were 60.46 ± 0.3 Gy, 1.62 ± 0.42 cc, 37.49 ± 5.78% and 54.79 ± 0.64 Gy in VMAT plans compared to 59.67 ± 0.21 Gy, 0.55 ± 0.22 cc, 25.49 ± 3.84% and 52.86 ± 0.88 Gy in combined technique plans (p = 0.002, 0.001, 0.001 and 0.001; respectively). The estimated 5-year progression-free and overall survival rates were 53.3% and 63.6%. Performance status and extent of surgery significantly influenced overall survival. None of the patients had serious toxicities. Conclusion: On the contrary to VMAT cone-down plans, it was possible to achieve adequate target coverage without violating brain stem constraints using the combination of VMAT and CyberKnife techniques in pediatric ependymoma of the fourth ventricle. The treatment protocol was well tolerated with no reported serious radiation toxicities.

show abstract