Journal of Neuro-Oncology

, Volume 106, Issue 2, pp 367–375

Pediatric intracranial ependymoma: the roles of surgery, radiation and chemotherapy

  • Sunanda Pejavar
  • Mei-Yin Polley
  • Sarah Rosenberg-Wohl
  • Sravana Chennupati
  • Michael D. Prados
  • Mitchel S. Berger
  • Anuradha Banerjee
  • Nalin Gupta
  • Daphne Haas-Kogan
Clinical Study - Patient Study

DOI: 10.1007/s11060-011-0671-9

Cite this article as:
Pejavar, S., Polley, MY., Rosenberg-Wohl, S. et al. J Neurooncol (2012) 106: 367. doi:10.1007/s11060-011-0671-9

Abstract

Management of pediatric intracranial ependymomas poses a major challenge, and optimal treatment remains controversial. We sought to investigate the roles of surgery, radiation, and chemotherapy in a historical cohort. Thirty-nine children, age 21 or younger, with non-metastatic intracranial ependymomas were treated from 1972 to 2008. Median age was 8 years (range 0.2–19.1). Twenty-one patients (54%) underwent GTRs, and 18 (45%) underwent STRs. Twenty-six patients (67%) received upfront adjuvant RT (67%), and 14 (44%) received adjuvant chemotherapy. Twenty-four patients had disease recurrence and 12 died. Only one patient recurred after 5 years. Median PFS was 2.7 years and median OS was 20 years. Fifteen year PFS and OS were 30 and 67%. Adjuvant RT was associated with improved PFS (P = 0.045), and remained significant after adjusting for EOR (P = 0.04). Greater EOR trended towards prolonged survival, but did not reach statistical significance (P = 0.156). Of the patients that underwent GTR, the median PFS was 38 months for those treated with adjuvant RT versus 30 months for those that were not treated with RT. Of the patients that had STR, the median PFS for those treated with RT was 26.3 months versus 6.9 months for those were not treated with RT. In conclusion, for localized intracranial pediatric ependymomas, adjuvant RT is associated with improved PFS, even after adjusting for EOR. Our findings suggest the benefit of RT even in the presence of GTR. Future prospective studies with larger sample number are needed to validate our findings.

Keywords

PediatricIntracranial ependymomaRadiationSurgeryChemotherapy

Abbreviations

PFS

Progression-free survival

OS

Overall survival

EOR

Extent of resection

GTR

Gross total resection

STR

Subtotal resection

RT

Radiation therapy

NED

No evidence of disease

CI

Confidence interval

PH

Proportional hazards

POG

Pediatric Oncology Group

CCG

Children’s Oncology Group

CT

Computed tomography

MRI

Magnetic resonance imaging

WHO

World Health Organization

CNS

Central nervous system

CSI

Craniospinal irradiation

3DCRT

3 Dimensional conformal radiation therapy

IMRT

Intensity modulated radiation therapy

Copyright information

© Springer Science+Business Media, LLC. 2011

Authors and Affiliations

  • Sunanda Pejavar
    • 1
  • Mei-Yin Polley
    • 1
  • Sarah Rosenberg-Wohl
    • 1
  • Sravana Chennupati
    • 1
  • Michael D. Prados
    • 1
  • Mitchel S. Berger
    • 1
  • Anuradha Banerjee
    • 1
  • Nalin Gupta
    • 1
  • Daphne Haas-Kogan
    • 1
  1. 1.Departments of Radiation Oncology, Neurosurgery, and PediatricsUniversity of California, San Francisco and UCSF Benioff Children’s HospitalSan FranciscoUSA