The role of postoperative radiotherapy in pediatric patients with grade II intracranial ependymomas: a population-based, propensity score-matched study

Deng, Xiaoyun; Lin, Dongdong; Yu, Lisheng; Xu, Xingxing; Zhang, Nu; Zhou, Hui; Huang, Song; Yin, Bo; Lin, Fei; Xu, Shang-Yu; Li, Dandong; Fang, Jun-Hao; Lu, Xiaoyong; Lin, Jian

doi:10.2147/cmar.s181900

Cited by 5 publications

(4 citation statements)

References 40 publications

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“…Tumor size was grouped by median value in both pediatric and adult cohorts. Tumor extension was divided into localized, regional and distant, in accordance with our previous report . According to SEER site‐specific coding guidelines, the extent of surgical resection was categorized as no surgery, biopsy/subtotal resection (STR), and gross total resection (GTR).…”

Section: Methodsmentioning

confidence: 99%

Personalizing age‐specific survival prediction and risk stratification in intracranial grade II/III ependymoma

et al. 2019

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Background: Models for estimation of survival rates of patients with intracranial grade II/III ependymoma (EPN) are scarce. Considering the heterogeneity in prognostic factors between pediatric and adult patients, we aimed to develop age-specific nomograms for predicting 3-, 5-, and 8-year survival for these patients. Methods: A total of 1390 cases (667 children; 723 adults) of intracranial grade II/ III EPNs diagnosed between 1988 and 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database for our study. Univariable and multivariable Cox analyses were employed to identify independent prognostic predictors. Age-specific nomograms were developed based on the results of multivariate Cox analyses. We also evaluated the performance of these predictive models by concordance index, calibration curves, time-dependent receiver operating characteristic curves, and decision curve analyses. Results: Considerable heterogeneity in prognostic factors was highlighted between pediatric and adult patients. Age, sex, tumor grade, surgery treatment and radiotherapy were identified as significant predictors of overall survival for children, and age, tumor grade, tumor size, surgery treatment, and marital status for adult. Based on these factors, age-specific nomogram models were established and internally validated. These models exhibited favorable discrimination and calibration characteristics. Nomogram-based risk classification systems were also constructed to facilitate risk stratification in EPNs for optimization of clinical management. Conclusions:We developed the first nomograms and corresponding risk classification systems for predicting survival in patients with intracranial grade II/III EPN.These easily used tools can assist oncologists in making accurate survival evaluation. K E Y W O R D Sgrade II/III ependymoma, intracranial, nomogram, overall survival, SEER 616 | DENG Et al.

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Section: Methodsmentioning

confidence: 99%

Personalizing age‐specific survival prediction and risk stratification in intracranial grade II/III ependymoma

et al. 2019

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“…The management of children with ependymoma is still a controversial topic in paediatric neuro-oncology and may vary among institutions, from only-surgery to a combination of surgery, RTH, CTH or even autologous hematopoietic stem cell transplant (autoHSCT, Table A1 ) [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , …”

Section: Discussionmentioning

confidence: 99%

“…Some studies found that young age could be a poor prognostic factor, as a result of a delay in diagnosis due to non-specific signs/symptoms, more aggressive tumour biology, and, what is the most important—the delay or avoidance of adjuvant RTH due to concerns of possible unacceptable toxicity [ 11 , 20 , 23 , 29 , 31 , 34 , 37 , 50 ]. Although authors who implemented such intensive treatment (surgery combined with immediate RTH) observed very good outcomes [ 6 , 7 , 21 , 26 , 31 ], Snider et al observed that 10-year OS was increased from 40% without RTH to 66% with RTH and from 43% to 51% in patients with grade III and grade II tumours, respectively [ 21 ]. Children in the Merchant et al prospective study were prescribed a td of 59.4 Gy, except those under the age of 18 months who achieved gross-total resection.…”

Section: Discussionmentioning

confidence: 99%

Polish Multi-Institutional Study of Children with Ependymoma—Clinical Practice Outcomes in the Light of Prospective Trials

et al. 2021

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We performed a multi-institutional analysis of 74 children with ependymoma to evaluate to what extent the clinical outcome of prospective trials could be reproduced in routine practice. The evaluation of factors that correlated with outcome was performed with a log rank test and a Cox proportional-hazard model. Survival was estimated with the Kaplan–Meier method. The majority of patients had brain tumours (89%). All had surgery as primary treatment, with adjuvant radiotherapy (RTH) and chemotherapy (CTH) applied in 78% and 57%, respectively. Median follow-up was 80 months and 18 patients died. Five- and 10-year overall survival (OS) was 83% and 73%. Progression was observed in 32 patients, with local recurrence in 28 cases. The presence of metastases was a negative prognostic factor for OS. Five- and 10-year progression-free survival (PFS) was 55% and 40%, respectively. The best outcome in patients with non-disseminated brain tumours was observed when surgery was followed by RTH (+/−CTH afterwards; p = 0.0001). Children under 3 years old who received RTH in primary therapy had better PFS (p = 0.010). The best outcome of children with ependymoma is observed in patients who received radical surgery followed by RTH, and irradiation should not be omitted in younger patients. The role of CTH remains debatable.

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“…In a series of 24 children over 5 years of age (20 infratentorial, 10 grade III and 16 with complete resection) treated with bi fractionated irradiation of 60 Gy in the case of complete resection and 66 Gy otherwise. OS and event-free survival at 5 years of age was 74% and 54% respectively [36] demonstrating the efficacy of radiotherapy in grade II EpPCF [37].…”

Section: Radiotherapymentioning

confidence: 92%

Posterior fossa ependymomas in children: still a challenge for pediatric neurosurgeons and oncologists.

Kala

Beuriat

Rocco

et al. 2021

Preprint

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Introduction: Posterior fossa ependymomas in children are associated with a poor prognosis. This retrospective study tries to determine prognostic factors for the outcomes and the quality of life. Material and Methods: Thirty-three patients with posterior fossa ependymomas were treated from 2002 to 2018. All patients had a cranio-spinal MRI and 3.12% were metastatic. Removal was complete in 29 patients (90.62%). All patients received a complementary treatment: 11patients chemotherapy, radiotherapy in 35 patients, 24 cases of neoadjuvant type and for recurrence in 11. Results: Average age was 5.8 years with a range from 9 months to 18 years. The sex ratio was 2.3 (M/F: 23/10). Sixteen patients had one recurrence (3 metastatic). 90% of the EpPCF were of the PFA group. Overall Survival was 65% with a mean follow-up of 8.4 and a median of 9 years. Twenty-one patients were alive (63.63%) at last follow-up. All were tumour-free according the MRI except 2 patients, 1 with a stable residue for 5 years and 1 in palliative treatment for metastatic recurrence for 5 years. Post-operative complications were as follow, facial nerve palsy in four cases (12.12%), swallowing disorders in three cases (9.09%), transient cerebellar syndrome in 4 cases (12.12%). Fifteen patients had normal schooling. Conclusion: Posterior fossa ependymomas are aggressive tumors. Complete surgical removal remains the most important prognostic factor even if responsible of sequels. Despite molecular studies and the expression of different genes, no obvious therapeutic target has yet emerged.

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The role of postoperative radiotherapy in pediatric patients with grade II intracranial ependymomas: a population-based, propensity score-matched study

Cited by 5 publications

References 40 publications

Personalizing age‐specific survival prediction and risk stratification in intracranial grade II/III ependymoma

Personalizing age‐specific survival prediction and risk stratification in intracranial grade II/III ependymoma

Polish Multi-Institutional Study of Children with Ependymoma—Clinical Practice Outcomes in the Light of Prospective Trials

Posterior fossa ependymomas in children: still a challenge for pediatric neurosurgeons and oncologists.

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