Prognostic factors and treatment options for paediatric ependymomas

J Clin Neurosci. 2012 Sep;19(9):1228-35. doi: 10.1016/j.jocn.2012.02.006. Epub 2012 Jul 25.

Abstract

The aim of this study was to determine factors of prognostic relevance for paediatric ependymomas, and evaluate the efficacy of treatment modalities. This is a retrospective study of 43 patients with ependymoma (<18 years) who underwent a combination of surgical excision, chemotherapy, and/or radiotherapy treatment at The Prince of Wales Cancer Centre between 1969 and 2009. Statistical analysis was performed to assess the prognostic relevance of various parameters affecting the two-year and five-year overall survival (OS) and progression-free survival (PFS). The five-year OS and PFS were 50.3% and 44.8% respectively (median follow-up 50 months). Eighteen patients (41.9%) experienced tumour recurrence: 13 had a local recurrence (LR) and five had both LR and distant recurrence. On univariate analysis, a more favourable prognosis in terms of both OS and PFS was evident for supratentorial tumours compared to infratentorial tumours (OS p=0.007, PFS p=0.045), stereotactic radiosurgery/ fractionated stereotactic radiotherapy compared to craniospinal irradiation or local posterior fossa/local brain±boost radiotherapy modalities (OS p=0.047, PFS p=0.031), total radiotherapy dose >50 Gy compared to ≤50 Gy (OS p=0.008, PFS p=0.005), and in patients with no tumour recurrence compared to those with recurrence (OS p=0.03, PFS p<0.001). Although not statistically significant, a more favourable multivariate outcome was evident in patients who underwent complete surgical resection. Chemotherapy treatment and histopathological grade, however, were not relevant to prognosis. This study supports the need to pursue more aggressive treatment for infratentorial and/or recurrent tumours. Ideal treatment involves maximal surgical resection, followed by adjuvant radiotherapy (>50 Gy).

MeSH terms

  • Adolescent
  • Age Factors
  • Biopsy
  • Brain Neoplasms / pathology
  • Brain Neoplasms / therapy*
  • Carcinoma / pathology
  • Carcinoma / therapy
  • Chemoradiotherapy
  • Child
  • Child, Preschool
  • Combined Modality Therapy
  • Disease-Free Survival
  • Ependymoma / pathology
  • Ependymoma / therapy*
  • Female
  • Humans
  • Infant
  • Magnetic Resonance Imaging
  • Male
  • Neoplasm Recurrence, Local / epidemiology
  • Nervous System Diseases / epidemiology
  • Nervous System Diseases / etiology
  • Neurosurgical Procedures
  • Postoperative Complications / epidemiology
  • Prognosis
  • Radiotherapy / adverse effects
  • Regression Analysis
  • Supratentorial Neoplasms / pathology
  • Supratentorial Neoplasms / therapy
  • Survival Analysis
  • Tomography, X-Ray Computed
  • Treatment Outcome