Radiat Oncol J.  2020 Mar;38(1):26-34. 10.3857/roj.2020.00073.

Treatment outcome of anaplastic ependymoma under the age of 3 treated by intensity-modulated radiotherapy

Affiliations
  • 1Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
  • 2Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
  • 3Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
  • 4Department of Radiation Oncology, Bundang CHA Medical Center, CHA University, Seongnam, Korea

Abstract

Purpose
Intensity-modulated radiotherapy (IMRT) allows for more precise treatment, reducing unwanted radiation to nearby structures. We investigated the safety and feasibility of IMRT for anaplastic ependymoma patients below 3 years of age.
Materials and Methods
A total of 9 anaplastic ependymoma patients below 3 years of age, who received IMRT between October 2011 and December 2017 were retrospectively reviewed. The median equivalent dose in 2 Gy fractions was 52.0 Gy (range, 48.0 to 60.0 Gy). Treatment outcomes and neurologic morbidities were reviewed in detail.
Results
The median patient age was 20.9 months (range, 12.1 to 31.2 months). All patients underwent surgery. The rates of 5-year overall survival, freedom from local recurrence, and progression-free survival were 40.6%, 53.3%, and 26.7%, respectively. Of the 9 patients, 5 experienced recurrences (3 had local recurrence, 1 had both local recurrence and cerebrospinal fluid [CSF] seeding, and 1 had CSF seeding alone). Five patients died because of disease progression. Assessment of neurologic morbidity revealed motor dysfunction in 3 patients, all of whom presented with hydrocephalus at initial diagnosis because of the location of the tumor and already had neurologic deficits before radiotherapy (RT).
Conclusion
Neurologic morbidity is not caused by RT alone but may result from mass effects of the tumor and surgical sequelae. Administration of IMRT to anaplastic ependymoma patients below 3 years of age yielded encouraging local control and tolerable morbidities. High-precision modern RT such as IMRT can be considered for very young patients with anaplastic ependymoma.

Keyword

Pediatrics; Anaplastic ependymoma; Intensity-modulated radiotherapy; Local control; Morbidity
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