Timing of adjuvant radiotherapy and treatment outcome in childhood ependymoma

Authors

  • Anthony Pak-Yin Liu MRCPCH,

    1. Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
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  • Matthew Ming-Kong Shing FRCP,

    1. Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
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  • Hui-Leung Yuen FRCP,

    1. Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, China
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  • Chak-Ho Li MRCP,

    1. Department of Paediatics and Adolescent Medicine, Tuen Mun Hospital, Hong Kong Special Administrative Region, China
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  • Siu-Cheung Ling FRCP,

    1. Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
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  • Chung-Wing Luk MRCP,

    1. Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, China
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  • Shau-Yin Ha FRCP,

    1. Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
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  • Chi-Kong Li MD,

    1. Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
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  • Dora Lai-Wan Kwong MD,

    1. Department of Clinical Oncology, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
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  • Godfrey Chi-Fung Chan MD

    Corresponding author
    1. Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
    • Correspondence to: Godfrey Chi-Fung Chan, Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.

      E-mail: gcfchan@hku.hk

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  • Conflict of interest: Nothing to declare.

Abstract

Background

Several trials incorporating adjuvant focal RT for treatment of young children with ependymoma have demonstrated improved survival with acceptable adverse effects. The optimal timing of RT administration is, however, unknown.

Procedure

A retrospective review of territory-wide database was performed to identify pediatric patients with ependymoma diagnosed between 1995 and 2011. OS and EFS were compared between patients receiving upfront RT (<150 days of diagnosis), delayed RT (≥150 days of diagnosis), or no RT.

Results

Thirty-one patients with intracranial ependymoma were identified. Median age was 3.5 years and 14 (45%) were male. Primary tumor was supratentorial in 10 (32%) and infratentorial in 21 (68%). All patients underwent initial surgery, with gross-total resection (GTR) in 27 (87%). Twelve (39%) received upfront RT, 10 (32%) had delayed RT and 9 (29%) had no RT. During the study period, there were 11 relapses (35%) and 10 deaths (32%). Five-year OS was 69.9% and 5yr-EFS was 49.3%. In univariate analysis, GTR led to improved OS (P < 0.001) and EFS (P = 0.004); superior OS and EFS was observed in patients who received RT when compared with those without (P = 0.018 and 0.011, respectively). Upfront RT also resulted in better OS and EFS than delayed RT (P = 0.049 and 0.014, respectively). No significant effect on survival was observed with age, sex, tumor location, RT dosage, and protocol used. In multivariate analysis, GTR significantly improved OS (P = 0.002) and EFS (P = 0.004).

Conclusions

Our results support the early initiation of adjuvant RT in the multi-modal management of pediatric ependymomas. Pediatr Blood Cancer 2014;61:606–611. © 2013 Wiley Periodicals, Inc.

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