The role of resection alone in select children with intracranial ependymoma: the Canadian Pediatric Brain Tumour Consortium experience View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2015-01

AUTHORS

Tamir Ailon, Christopher Dunham, Anne-Sophie Carret, Uri Tabori, P. Daniel Mcneely, Shayna Zelcer, Beverley Wilson, Lucie Lafay-Cousin, Donna Johnston, David D. Eisenstat, Marianna Silva, Nada Jabado, Karen Jane Goddard, Chris Fryer, Glenda Hendson, Cynthia Hawkins, Sandra Dunn, Stephen Yip, Ashutosh Singhal, Juliette Hukin

ABSTRACT

PURPOSE: Gross total resection (GTR) of intracranial ependymoma is an accepted goal. More controversial is radiotherapy deferral. This study reports on children treated with gross total resection who did not receive upfront adjuvant radiotherapy. METHODS: We conducted a retrospective review of children with intracranial ependymoma in 12 Canadian centers. Patients who had GTR of their tumor and no upfront radiotherapy were identified. Immunostaining was performed for Ki-67, epidermal growth factor receptor (EGFR), and EZH2 on archived tissue. The Kaplan-Meier survival analysis was performed and compared with those who had GTR followed by radiation. RESULTS: Twenty-six children were identified treated with GTR alone at diagnosis; 12 posterior fossa ependymoma (PFE) WHO grade II, and 14 supratentorial ependymoma (STE). Progression-free survival (PFS) in ependymoma treated with GTR alone at diagnosis was inferior in those with high Ki-67 or positive EZH2 immunostaining. Survival was inferior for patients less than 2 years old at diagnosis (p = 0.002). Survival was comparable to PFE WHO grade II and STE who had GTR followed by radiation (p = 0.62). Five-year PFS and overall survival (OS) of those treated with GTR alone were 60 and 70% respectively for PFE and 45 and 70% respectively for STE (p = 0.2; 0.55). CONCLUSIONS: This study suggests that there is a subset of children with certain biologic features who, in the setting of a prospective clinical trial, might be candidates for observation following GTR. Good risk factors for this approach include age of 2 years or older, low Ki-67, and negative EZH2. If relapse occurs, it may be confined to the primary site, allowing for possible salvage with GTR followed by XRT. More... »

PAGES

57-65

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00381-014-2575-4

DOI

http://dx.doi.org/10.1007/s00381-014-2575-4

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1035724779

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/25391979


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