Treatment of intracranial ependymomas of children: review of a 15-year experience

Rousseau, Pierre; Habrand, Jean‐Louis; Sarrazin, D.; Kalifa, Chantal; Terrier-Lacombe, Marie-Josée; Rekacewicz, Claire; Rey, Annie

doi:10.1016/0360-3016(94)90061-2

Cited by 199 publications

(148 citation statements)

References 18 publications

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“…Many studies had Grade II ependymomas that were up to two to three times more frequent than Grade III tumors. 3,4,6,9,11,14,15,17,20,22,24,25,30 In some studies this ratio was almost equal, 13,19,[33][34][35] while in others there were far more Grade III than Grade II ependymomas. 12,26,28,29,31,32 In one study of ependymomas in children under 5 years of age, the authors reported eight Grade II and 60 Grade III ependymomas.…”

Section: Pediatric Posterior Fossa Ependymomas T Tihan Et Almentioning

confidence: 96%

The prognostic value of histological grading of posterior fossa ependymomas in children: a Children's Oncology Group study and a review of prognostic factors

et al. 2008

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We performed a retrospective analysis of 96 pediatric posterior fossa ependymomas in order to determine the prognostic value of histological grade based on the current WHO grading scheme. The patients were selected among Children's Oncology Group (previously Pediatric Oncology Group-POG) patients enrolled in clinical trials, and on the basis of central pathology review, location, and age. We excluded entities such as subependymoma, myxopapillary, or clear-cell ependymoma, after a consensus diagnosis by three neuropathologists. A total of 66 males and 30 females with a median age of 48 months were identified. The group was analyzed to determine the effects of histological grade, age, gender, and extent of resection on event-free and overall survival. Our results showed that extent of resection, age, and histological grade were independent prognostic variables for event-free survival. The relative risk for extent of resection and histological grade was calculated as 3.59 (Po0.001) and 3.58 (Po0.001), respectively. Overall survival significantly correlated with extent of resection and age, but not with histological grade. We compared our results with peer-reviewed publications on pediatric intracranial ependymomas in the English language between 1990 and 2005. Selection criteria identified 32 manuscripts involving 1444 patients. Extent of resection was a significant factor in 21, age in 12, and histological grading in nine of these studies. Other factors reported to be significant by more than one study included tumor location and radiation treatment. Our findings suggest that histological grade (WHO Grade II vs III) is an independent prognostic indicator for event-free survival, but may not be so for overall survival in pediatric posterior fossa ependymomas. We believe that an accurate assessment of the prognostic value of histological grade depends on the selection of a well-characterized clinical cohort of sufficient size, and the inclusion of relevant histological criteria as outlined in the WHO classification scheme.

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Section: Pediatric Posterior Fossa Ependymomas T Tihan Et Almentioning

confidence: 96%

The prognostic value of histological grading of posterior fossa ependymomas in children: a Children's Oncology Group study and a review of prognostic factors

et al. 2008

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“…Multiple studies have shown adequate control with radiation targeted to the initially involved area. [151][152][153] The experience from St. Jude's hospital demonstrated a 3-year PFS of 69.5% in a phase II trial using conformal radiotherapy in 88 children with ependymoma (55% Ͻ3 years of age). Serial neurocognitive evaluations demonstrated no significant decline before and after radiation therapy independent of age.…”

Section: Radiation Therapymentioning

confidence: 99%

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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“…The standard therapy for childhood ependymoma is surgery followed by adjuvant radiation 1, 2. Historically, cranial or craniospinal irradiation was the standard treatment after surgery3 in order to assure that the volume adjacent to the target receives adequate dose and consequently assure local control.…”

Section: Introductionmentioning

confidence: 99%

Second cancer risk after radiation therapy of ependymoma using the flattening filter free irradiation mode of a linear accelerator

Moret

Obermeier

Pohl

et al. 2018

J Applied Clin Med Phys

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Pediatric patients suffering from ependymoma are usually treated with cranial or craniospinal three‐dimensional (3D) conformal radiotherapy (3DCRT). Intensity‐modulated techniques spare dose to the surrounding tissue, but the risk for second malignancies may be increased due to the increase in low‐dose volume. The aim of this study is to investigate if the flattening filter free (FFF) mode allows reducing the risk for second malignancies compared to the mode with flattening filter (FF) for intensity‐modulated techniques and to 3DCRT. A reduction of the risk would be advantageous for treating pediatric ependymoma. 3DCRT was compared to intensity‐modulated radiation therapy (IMRT) and volumetric‐modulated arc therapy (VMAT) with and without flattening filter. Dose–volume histograms (DVHs) were compared to evaluate the plan quality and used to calculate the excess absolute risk (EAR) to develop second cancer in the brain. Dose verification was performed with a two‐dimensional (2D) ionization chamber array and the out‐of‐field dose was measured with an ionization chamber to determine the EAR in peripheral organs. Delivery times were measured. Both VMAT and IMRT achieved similar plan quality in terms of dose sparing in the OAR and higher PTV coverage as compared to 3DCRT. Peripheral dose in low‐dose region, which is proportional to the EAR in organs located in this region, for example, gonads, bladder, or bowel, could be significantly reduced using FFF. The lowest peripheral EAR and lowest delivery times were hereby achieved with VMATFFF. The EAR calculated based on DVH in the brain could not be reduced using FFF mode. VMATFFF improved the target coverage and homogeneity and kept the dose in the OAR similar compared to 3DCRT. In addition, delivery times were significantly reduced using VMATFFF. Therefore, for radiotherapy of ependymoma patients, VMATFFF may be considered advantageous for the combination of Elekta Synergy linac and Oncentra External Beam planning system used in this study.

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Treatment of intracranial ependymomas of children: review of a 15-year experience

Cited by 199 publications

References 18 publications

The prognostic value of histological grading of posterior fossa ependymomas in children: a Children's Oncology Group study and a review of prognostic factors

The prognostic value of histological grading of posterior fossa ependymomas in children: a Children's Oncology Group study and a review of prognostic factors

Pediatric Brain Tumors: Current Treatment Strategies and Future Therapeutic Approaches

Second cancer risk after radiation therapy of ependymoma using the flattening filter free irradiation mode of a linear accelerator

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