A systematic review and meta-analysis of outcomes in pediatric, recurrent ependymoma

J Neurooncol. 2019 Sep;144(3):445-452. doi: 10.1007/s11060-019-03255-3. Epub 2019 Sep 9.


Purpose: The purpose of this study was to determine outcomes in recurrent pediatric ependymoma.

Methods: We performed a systematic review of PubMed, Embase, Web of Science and the Cochrane Library for studies reporting on survival outcomes for pediatric patients with recurrent ependymoma. We then performed a meta-analysis of all eligible results. Survival outcomes were identified across location of recurrence, therapy at recurrence, and age at recurrence.

Results: Eleven studies met final inclusion criteria. Pooled median progression free survival (PFS) from date of first recurrence was 6.7 months (95% confidence interval [95% CI] 4.7-8.8). Pooled median overall survival (OS) from date of first recurrence was 11.2 months (95% CI 6.4-16.0). Participants with supratentorial recurrences demonstrated a shorter OS of 8.3 months (95% CI 3.2-13.3) compared to 20.1 months (95% CI 8.4-31.7) for those with infratentorial recurrence. Patients who underwent surgery at recurrence had a median OS of 24.2 months (95% CI 14.2-34.1) compared to 29.2 months (95% CI 17.4-41.1) in those who received radiation compared to 19.3 months (95% CI 10.3-28.3) in those who received chemotherapy. Patients younger than age 3 years at time of recurrence demonstrated a median OS of 31.0 months (95% CI - 25.3-87.3) compared to 17.5 months (95% CI 9.9-25.2) for those that recurred beyond 3 years of age.

Conclusions: Our findings illustrate that children with recurrent ependymoma suffer from poor outcomes; however, these outcomes range widely depending on patient, tumor, and treatment characteristics. New therapies and treatment strategies are needed to improve outcomes in this group.

Keywords: Ependymoma; Pediatric; Recurrent; Systematic review.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Child
  • Combined Modality Therapy
  • Ependymoma / mortality*
  • Ependymoma / therapy
  • Humans
  • Neoplasm Recurrence, Local / mortality*
  • Neoplasm Recurrence, Local / therapy
  • Survival Rate
  • Treatment Outcome