Re-irradiation of recurrent pediatric ependymoma: modalities and outcomes: a twenty-year survey

Maria Jesus Lobón, Francisco Bautista, François Riet, Frederic Dhermain, Sandra Canale, Christelle Dufour, Thomas Blauwblomme, Michel Zerah, Kevin Beccaria, Christian Saint-Rose, Stephanie Puget, Christian Carrie, Eric Lartigau, Pierre-Yves Bondiau, Dominique Valteau-Couanet, Jacques Grill, Stephanie Bolle

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Standard treatment for recurrent ependymomas is not defined. Re- irradiation has been proposed but its modalities and results are still to be explored.

PATIENTS AND METHODS: From June 1994 to December 2013, 32 pediatric patients with ependymoma were re-irradiated for local (n = 15) or metastatic (n = 17) relapses. Files were reviewed retrospectively.

RESULTS: Local relapses were treated with hypofractionated focal radiotherapy (hypoFFRT) (n = 8) or focal fractionated radiotherapy (FFRT) (n = 7). Metastatic relapses were treated with hypoFFRT (n = 3), FFRT (n = 3), spinal radiotherapy (n = 4) and craniospinal irradiation (CSI) (n = 7). Median PFS and OS after re-irradiation were 1.2 and 3.5 years respectively with a median follow-up of 2.1 years (0.2-11.4). For local relapses, median PFS was 2.5 years for patients treated with hypoFFRT versus 1.2 years for patients treated with FFRT (p = 0.2). For metastatic relapses, median PFS was 0.7 years for patients treated with focal radiotherapy (hypoFFRT, FFRT, spinal radiotherapy) versus 6.8 years for patients treated with CSI (p = 0.073). 15 patients achieved greater PFS after second radiotherapy (RT2) than after first radiotherapy (RT1). 27 patients (84 %) had surgery before re-irradiation. PFS was better for patients with GTR before RT2 (14.7 vs 6.7 months) (p = 0.05). 5 patients developed radionecrosis; only one required corticosteroids.

CONCLUSION: Re-irradiation at relapse is a safe, feasible and potentially curative treatment. Metastatic relapse may require CSI even when isolated and re-operated. For local relapses, considering conflicting results in the literature, a randomized trial is warranted to explore fractionated focal radiotherapy versus hypofractionated focal irradiation.

Original languageEnglish
Pages (from-to)879
JournalSpringerPlus
Volume5
Issue number1
DOIs
Publication statusPublished - 2016
Externally publishedYes

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