Child's Nervous System

, 25:1383 | Cite as

Ependymoma: lessons from the past, prospects for the future

  • Eric BouffetEmail author
  • Uri Tabori
  • Annie Huang
  • Ute Bartels
Letter to the Editor

Dear Editor:

The invited review from Little et al. sheds a light on the potentially hazardous arbitrary decision-making process physicians may use in the management of intracranial ependymoma [6]. Based on their review of the literature, Little et al. conclude that “deferring adjuvant radiotherapy for low-risk patients with childhood ependymomas who have undergone complete resection is a reasonable treatment option”. This statement is problematic since a significant number of readers may consider it as a take home message and apply this recommendation in their daily practice.

Unfortunately, the history of childhood ependymoma has already suffered the consequences of similar arbitrary statements in the early 1980 when Salazar et al., based on a review of autopsy material concluded that patients with high-grade ependymomas (regardless of location) or with low-grade infratentorial tumors with positive CSF or subarachnoid findings of spinal metastases should be treated with craniospinal...


Postoperative Radiation Spinal Metastasis Craniospinal Radiation hTERT Expression Pediatric Patient Population 
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  1. 1.
    Awaad YM, Allen JC, Miller DC, Schneider SJ, Wisoff J, Epstein FJ (1996) Deferring adjuvant therapy for totally resected intracranial ependymoma. Pediatr Neurol 14:216–219PubMedCrossRefGoogle Scholar
  2. 2.
    Bouffet E, Perilongo G, Canete A, Massimino M (1998) Intracranial ependymomas in children: a critical review of prognostic factors and a plea for cooperation. Med Pediatr Oncol 30:319–329 discussion 329–331PubMedCrossRefGoogle Scholar
  3. 3.
    Grill J, Le Deley MC, Gambarelli D, Raquin MA, Couanet D, Pierre-Kahn A, Habrand JL, Doz F, Frappaz D, Gentet JC, Edan C, Chastagner P, Kalifa C (2001) Postoperative chemotherapy without irradiation for ependymoma in children under 5 years of age: a multicenter trial of the French Society of Pediatric Oncology. J Clin Oncol 19:1288–1296PubMedGoogle Scholar
  4. 4.
    Grundy RG, Wilne SA, Weston CL, Robinson K, Lashford LS, Ironside J, Cox T, Chong WK, Campbell RH, Bailey CC, Gattamaneni R, Picton S, Thorpe N, Mallucci C, English MW, Punt JA, Walker DA, Ellison DW, Machin D (2007) Primary postoperative chemotherapy without radiotherapy for intracranial ependymoma in children: the UKCCSG/SIOP prospective study. Lancet Oncol 8:696–705PubMedCrossRefGoogle Scholar
  5. 5.
    Hukin J, Epstein F, Lefton D, Allen J (1998) Treatment of intracranial ependymoma by surgery alone. Pediatr Neurosurg 29:40–45PubMedCrossRefGoogle Scholar
  6. 6.
    Little AS, Sheean T, Manoharan R, Darbar A, Teo C (2009) The management of completely resected childhood intracranial ependymoma: the argument for observation only. Childs Nerv Syst 25:281–284PubMedCrossRefGoogle Scholar
  7. 7.
    Merchant TE, Li C, Xiong X, Kun LE, Boop FA, Sanford RA (2009) Conformal radiotherapy after surgery for paediatric ependymoma: a prospective study. Lancet Oncol 10:258–266PubMedCrossRefGoogle Scholar
  8. 8.
    Ridley L, Rahman R, Brundler MA, Ellison D, Lowe J, Robson K, Prebble E, Luckett I, Gilbertson RJ, Parkes S, Rand V, Coyle B, Grundy RG (2008) Multifactorial analysis of predictors of outcome in pediatric intracranial ependymoma. Neurooncol 10:675–689Google Scholar
  9. 9.
    Salazar OM, Castro-Vita H, VanHoutte P, Rubin P, Aygun C (1983) Improved survival in cases of intracranial ependymoma after radiation therapy. Late report and recommendations. J Neurosurg 59:652–659PubMedCrossRefGoogle Scholar
  10. 10.
    Tabori U, Ma J, Carter M, Zielenska M, Rutka J, Bouffet E, Bartels U, Malkin D, Hawkins C (2006) Human telomere reverse transcriptase expression predicts progression and survival in pediatric intracranial ependymoma. J Clin Oncol 24:1522–1528PubMedCrossRefGoogle Scholar
  11. 11.
    Tabori U, Wong V, Ma J, Shago M, Alon N, Rutka J, Bouffet E, Bartels U, Malkin D, Hawkins C (2008) Telomere maintenance and dysfunction predict recurrence in paediatric ependymoma. Br J Cancer 99:1129–1135PubMedCrossRefGoogle Scholar
  12. 12.
    Zacharoulis S, Levy A, Chi SN, Gardner S, Rosenblum M, Miller DC, Dunkel I, Diez B, Sposto R, Ji L, Asgharzadeh S, Hukin J, Belasco J, Dubowy R, Kellie S, Termuhlen A, Finlay J (2007) Outcome for young children newly diagnosed with ependymoma, treated with intensive induction chemotherapy followed by myeloablative chemotherapy and autologous stem cell rescue. Pediatr Blood Cancer 49:34–40PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Eric Bouffet
    • 1
    Email author
  • Uri Tabori
    • 1
  • Annie Huang
    • 1
  • Ute Bartels
    • 1
  1. 1.Neuro-oncology program, Division of Haematology/Oncologythe Hospital for Sick ChildrenTorontoCanada

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