Treatment outcome of anaplastic ependymoma under the age of 3 treated by intensity-modulated radiotherapy

Abstract

Ependymoma is the third most common pediatric brain tumor [1]. Thirty percent of all pediatric ependymomas occur in children below 3 years of age [2]. The 7-year local control and event-free survival rates in pediatric ependymoma patients undergoing current treatment regimens (maximal safe resection, followed by focal adjuvant radiotherapy [RT]) were reported to be 83.7% and 69.1%, respectively [3]. In particular, both progression-free survival (PFS) and overall survival (OS) were significantly worse in patients with anaplastic ependymoma (grade III) than in patients with grade II ependymoma [4]. Although RT is indispensable for the prevention of local recurrence of anaplastic ependymoma, the exposure of normal tissue to radiation may lead to acute or late toxicity. There are many reports of long-term sequelae of central nervous system (CNS) tumors,

Chronological Analysis of Acute Hematological Outcomes after Proton and Photon Beam Craniospinal Irradiation in Pediatric Brain Tumors

“…CSI is an essential treatment for pediatric brain tumors that tend to spread to the leptomeningeal space [1]. However, the volume irradiated by CSI is very large and a range of toxicities, including hematological and gastrointestinal complications, are observed during and after CSI [3][4][5][6][7]. Due to the absence of an exit dose for CSI compared with photon beams, it has been expected that PBT would reduce these toxicities [3,9].…”

“…Owing to the large field size, a significant volume of normal organs is included in the irradiated area [2]. Therefore, various side effects, including hematological and gastrointestinal toxicities, are observed during and after CSI [3][4][5][6][7]. In an effort to reduce the potential toxicities related to CSI, advanced techniques have been adapted.…”

Adaptive Convergence of Methylomes Reveals Epigenetic Drivers and Boosters of Repeated Relapses in Patient-matched Childhood Ependymomas and Identifies Targets for Anti-Recurrence Therapies

“…It indicates a decreased cellular heterogeneity of DNA methylation in the recurrent tumors, a result different from previous reports on the increased or expanded gene mutation loads in the recurrent cancers 39 . One possible explanation is that radiation therapy, which remains the mainstay of clinical treatment in pediatric EPNs 1,3,93 , selected or conditioned a subpopulation of surviving tumor cells for relapse. This result is clinically important as it suggested a possibility of targeting a small set of epigenetic drivers of recurrence for significantly improved efficacy.…”

“…Ependymoma (EPN) is the third most common malignant brain tumor of childhood, accounting for up to 12% of intracranial tumors in children. Current therapy includes maximal surgical resection and focal radiation, resulting in a 5-year overall survival (OS) and progression-free survival (PFS) of 70% and 57%, respectively [1][2][3][4][5][6][7] . However, nearly half of patients will experience late relapses 1,4,6 .…”

Childhood Cancer: Occurrence, Treatment and Risk of Second Primary Malignancies

“…Therefore, the low-dose region does not seem to be most relevant for the development of second primary CNS tumors after cranial EBRT supporting the application of more conformal IMRT-based techniques. Although the successful therapy of pediatric primary CNS tumors is the major goal, there is an urgent need to lower the dose and volume of EBRT in the normal tissue and to organs at risk by highly dose-conformal IMRT, SBRT, and proton or hadron therapy in still physically and cognitively developing patients [ 320 , 329 , 330 , 331 ]. For pediatric CNS tumor patients, a large benefit is expected from the application of proton therapy allowing for a meaningful reduction of the dose burden to the healthy tissue with the option of simultaneous focal dose escalation in the tumor volume for highly resistant entities [ 35 , 320 ].…”