Evolution of neurological impairment in pediatric infratentorial ependymoma patients

E. Brannon Morris, Chenghong Li, Raja B. Khan, Robert A. Sanford, Frederick Boop, Renee Pinlac, Xiaoping Xiong, Thomas E. Merchant

Research output: Contribution to journalArticle

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Abstract

Background: Infratentorial ependymoma is a common central nervous system tumor of childhood and in patients >1 year of age is treated with maximally feasible surgical resection and radiotherapy. Because of this tumor typically arises within the 4th ventricle and can invade the brainstem, patients are at risk for significant neurological impairment. Purpose: To characterize the incidence, evolution, and persistence of neurologic impairment in children with infratentorial ependymoma following maximal safe surgery and conformal or intensity-modulated radiation therapy (CRT/IMRT). Patients and Methods: After surgical resection, 96 children with non-metastatic infratentorial ependymoma were enrolled on a phase II study of image-guided radiation therapy and were prospectively followed with interval comprehensive neurological examinations. Late adverse neurological severity was graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE), version 3.0. Results: The most common deficits detected at baseline examination were limb dysmetria, cranial nerve VI/VII palsy, limb paresis, dysphagia, and truncal ataxia/hypotonia. When present, gait dysfunction and dysphagia were often severe. Oculomotor dysfunction, facial paresis, dysphagia, and gait impairment improved over time. With the exception of hearing loss, in the survivor cohort, very few severe late effects (CTCAE Grade 3/4/5) were present at 60 months survival. Conclusion: In general, neurological deficits were maximal in the post-operative period and either remained stable or improved during radiation and the post-treatment evaluation period. With the exception of hearing, the majority of chronic residual neurological deficits in this at-risk population are mild and only minimally intrude upon daily life.

Original languageEnglish (US)
Pages (from-to)391-398
Number of pages8
JournalJournal of Neuro-Oncology
Volume94
Issue number3
DOIs
StatePublished - Apr 8 2009

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Ependymoma
Deglutition Disorders
Pediatrics
Gait
Terminology
Radiotherapy
Extremities
Image-Guided Radiotherapy
Abducens Nerve Diseases
Fourth Ventricle
Central Nervous System Neoplasms
Cerebellar Ataxia
Muscle Hypotonia
National Cancer Institute (U.S.)
Facial Paralysis
Facial Nerve
Neurologic Examination
Paresis
Ataxia
Hearing Loss

All Science Journal Classification (ASJC) codes

  • Cancer Research
  • Clinical Neurology
  • Oncology
  • Neurology

Cite this

Brannon Morris, E., Li, C., Khan, R. B., Sanford, R. A., Boop, F., Pinlac, R., ... Merchant, T. E. (2009). Evolution of neurological impairment in pediatric infratentorial ependymoma patients. Journal of Neuro-Oncology, 94(3), 391-398. https://doi.org/10.1007/s11060-009-9866-8

Evolution of neurological impairment in pediatric infratentorial ependymoma patients. / Brannon Morris, E.; Li, Chenghong; Khan, Raja B.; Sanford, Robert A.; Boop, Frederick; Pinlac, Renee; Xiong, Xiaoping; Merchant, Thomas E.

In: Journal of Neuro-Oncology, Vol. 94, No. 3, 08.04.2009, p. 391-398.

Research output: Contribution to journalArticle

Brannon Morris, E, Li, C, Khan, RB, Sanford, RA, Boop, F, Pinlac, R, Xiong, X & Merchant, TE 2009, 'Evolution of neurological impairment in pediatric infratentorial ependymoma patients', Journal of Neuro-Oncology, vol. 94, no. 3, pp. 391-398. https://doi.org/10.1007/s11060-009-9866-8
Brannon Morris, E. ; Li, Chenghong ; Khan, Raja B. ; Sanford, Robert A. ; Boop, Frederick ; Pinlac, Renee ; Xiong, Xiaoping ; Merchant, Thomas E. / Evolution of neurological impairment in pediatric infratentorial ependymoma patients. In: Journal of Neuro-Oncology. 2009 ; Vol. 94, No. 3. pp. 391-398.
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