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Extent of re-excision, sequence/timing of salvage re-irradiation, and disease-free interval impact upon clinical outcomes in recurrent/progressive ependymoma

  • Clinical Study
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Abstract

Purpose

To report clinical outcomes of salvage re-irradiation (re-RT) in recurrent/progressive ependymoma.

Methods

Medical records of patients treated with curative-intent re-RT as multi-modality management for recurrent/progressive ependymoma were analyzed retrospectively. The linear-quadratic model was used to provide estimates of biologically effective dose (BED) of irradiation using an α/β value of 2 for late CNS toxicity for each course of irradiation and summated to derive cumulative BED without correcting for the assumed recovery.

Results

A total of 55 patients (median age 10 years at index diagnosis) treated with curative-intent re-RT between 2010 and 2018 were included. Median time to first recurrence was 29 months with an inter-quartile range (IQR) of 16–64 months. Majority (n = 46, 84%) of patients underwent surgical re-excision of recurrent disease. Median interval from first course of irradiation (RT1) to second course (RT2) was 35 months (IQR = 26–66 months) with a median re-RT dose of 54 Gy in 30 fractions (range 40–60 Gy), resulting in median cumulative equivalent dose in 2 Gy fraction (EQD2) of 106.2 Gy (range 92.4–117.6 Gy). Volume of re-RT was based on location and pattern of relapse, comprising uni-focal (n = 49, 89%), multi-focal (n = 3, 5.5%), or craniospinal irradiation (CSI) in 3 (5.5%) patients respectively. Thirty-six (66%) patients received platinum-based salvage chemotherapy either before or after RT2. At a median follow up of 37 months (range 6–80 months), the Kaplan–Meier estimates of 3-year progression-free survival (PFS) and overall survival (OS) for the entire study cohort were 40% and 51% respectively. Gross total resection at recurrence; early salvage re-RT (prior to chemotherapy, if any); and longer (> 2 years) disease-free interval (DFI) were associated with better survival outcomes. Salvage re-RT was generally well tolerated with only 3 (5.5%) patients developing symptomatic radiation necrosis necessitating corticosteroids.

Conclusion

Extent of re-excision, sequence/timing of re-RT, and DFI impact upon outcomes in curative-intent, multi-modality salvage therapy for recurrent ependymoma.

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Funding

No source of funding was involved in this retrospective study.

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Authors and Affiliations

  1. Departments of Radiation Oncology, Advanced Centre for Treatment Research & Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Mumbai, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, India

    Tejpal Gupta, Madan Maitre, Priyamvada Gupta, Rahul Krishnatry, Abhishek Chatterjee & Jayant GodaSastri

  2. Departments of Neuro-Surgical Oncology, Advanced Centre for Treatment Research & Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Mumbai, Homi Bhabha National Institute (HBNI), Mumbai, India

    Aliasgar Moiyadi, Prakash Shetty & Vikas Singh

  3. Departments of Pediatric Oncology, Advanced Centre for Treatment Research & Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Mumbai, Homi Bhabha National Institute (HBNI), Mumbai, India

    Girish Chinnaswamy

  4. Departments of Pathology, Advanced Centre for Treatment Research & Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Mumbai, Homi Bhabha National Institute (HBNI), Mumbai, India

    Sridhar Epari & Ayushi Sahay

  5. Departments of Medical Oncology, Advanced Centre for Treatment Research & Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Mumbai, Homi Bhabha National Institute (HBNI), Mumbai, India

    Vijay Patil

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  1. Tejpal Gupta
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Correspondence to Tejpal Gupta.

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Gupta, T., Maitre, M., Gupta, P. et al. Extent of re-excision, sequence/timing of salvage re-irradiation, and disease-free interval impact upon clinical outcomes in recurrent/progressive ependymoma. J Neurooncol 147, 405–415 (2020). https://doi.org/10.1007/s11060-020-03434-7

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