TY - JOUR
T1 - Re-irradiation of recurrent pediatric ependymoma
T2 - modalities and outcomes: a twenty-year survey
AU - Lobón, Maria Jesus
AU - Bautista, Francisco
AU - Riet, François
AU - Dhermain, Frederic
AU - Canale, Sandra
AU - Dufour, Christelle
AU - Blauwblomme, Thomas
AU - Zerah, Michel
AU - Beccaria, Kevin
AU - Saint-Rose, Christian
AU - Puget, Stephanie
AU - Carrie, Christian
AU - Lartigau, Eric
AU - Bondiau, Pierre Yves
AU - Valteau-Couanet, Dominique
AU - Grill, Jacques
AU - Bolle, Stephanie
N1 - Publisher Copyright:
© 2016, The Author(s).
PY - 2016/6/24
Y1 - 2016/6/24
N2 - 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.
AB - 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.
KW - Children
KW - Ependymoma
KW - Radiosurgery
KW - Radiotherapy
KW - Recurrent
UR - https://www.scopus.com/pages/publications/84976400543
U2 - 10.1186/s40064-016-2562-1
DO - 10.1186/s40064-016-2562-1
M3 - Article
C2 - 27386327
AN - SCOPUS:84976400543
SN - 2193-1801
VL - 5
JO - SpringerPlus
JF - SpringerPlus
IS - 1
M1 - 879
ER -