Outcomes After Reirradiation for Recurrent Pediatric Intracranial Ependymoma

Derek S. Tsang, Elizabeth Burghen, Paul Klimo, Frederick Boop, David W. Ellison, Thomas E. Merchant

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Purpose: To determine the long-term outcomes and the optimal dose and volume for reirradiation of recurrent pediatric ependymoma. Methods and Materials: Patients with recurrent ependymoma treated with a second course of fractionated radiation therapy (RT2) were reviewed retrospectively. Eligible patients had localized, intracranial ependymoma at initial diagnosis that was treated with focal radiation (RT1) without craniospinal irradiation (CSI) and were aged ≤21 years at the time of RT2. The median doses of RT1, focal RT2, and CSI-RT2 were 59.4, 54, and 39.6 Gy, respectively. The primary endpoint, overall survival (OS), was measured from the first day of RT2. Results: We included 101 patients in the study. The median interval between RT1 and RT2 was 26.8 months (interquartile range, 18.0-43.1). The median durations of OS and freedom from progression (FFP) were 75.1 and 27.3 months, respectively. Male sex and anaplastic histology at recurrence were associated with decreased OS and FFP on multivariate analysis. Distant-only failure treated with CSI-RT2 was independently associated with improved OS compared with individuals with local failure treated with focal RT2 (hazard ratio 0.37; 95% confidence interval 0.16-0.87). Among individuals experiencing any distant failure after RT1, gain of chromosome 1q was adversely associated with poorer OS (hazard ratio 3.5; 95% confidence interval 1.1-10.6). No distant-only failures were observed in individuals with RT1 local failure who received CSI-RT2 (n=10). The 10-year cumulative incidence of grade ≥3 radiation necrosis after RT2 was 7.9%. Conclusions: Reirradiation for relapsed pediatric ependymoma was well tolerated by most patients and resulted in long-term survival in a subset of patients. The best results were observed in patients who experienced distant-only failure after RT1 and were treated with CSI as part of RT2, without anaplasia at recurrence. The option of reirradiation should be discussed with patients who develop recurrent ependymoma.

Original languageEnglish (US)
Pages (from-to)507-515
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Volume100
Issue number2
DOIs
StatePublished - Feb 1 2018

Fingerprint

Ependymoma
Craniospinal Irradiation
Pediatrics
Survival
irradiation
intervals
progressions
hazards
confidence
Anaplasia
Confidence Intervals
Radiation
Recurrence
dosage
histology
necrosis
chromosomes
radiation
Re-Irradiation
set theory

All Science Journal Classification (ASJC) codes

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Outcomes After Reirradiation for Recurrent Pediatric Intracranial Ependymoma. / Tsang, Derek S.; Burghen, Elizabeth; Klimo, Paul; Boop, Frederick; Ellison, David W.; Merchant, Thomas E.

In: International Journal of Radiation Oncology Biology Physics, Vol. 100, No. 2, 01.02.2018, p. 507-515.

Research output: Contribution to journalArticle

Tsang, Derek S. ; Burghen, Elizabeth ; Klimo, Paul ; Boop, Frederick ; Ellison, David W. ; Merchant, Thomas E. / Outcomes After Reirradiation for Recurrent Pediatric Intracranial Ependymoma. In: International Journal of Radiation Oncology Biology Physics. 2018 ; Vol. 100, No. 2. pp. 507-515.
@article{1810a5139afd42658076b932aec314b1,
title = "Outcomes After Reirradiation for Recurrent Pediatric Intracranial Ependymoma",
abstract = "Purpose: To determine the long-term outcomes and the optimal dose and volume for reirradiation of recurrent pediatric ependymoma. Methods and Materials: Patients with recurrent ependymoma treated with a second course of fractionated radiation therapy (RT2) were reviewed retrospectively. Eligible patients had localized, intracranial ependymoma at initial diagnosis that was treated with focal radiation (RT1) without craniospinal irradiation (CSI) and were aged ≤21 years at the time of RT2. The median doses of RT1, focal RT2, and CSI-RT2 were 59.4, 54, and 39.6 Gy, respectively. The primary endpoint, overall survival (OS), was measured from the first day of RT2. Results: We included 101 patients in the study. The median interval between RT1 and RT2 was 26.8 months (interquartile range, 18.0-43.1). The median durations of OS and freedom from progression (FFP) were 75.1 and 27.3 months, respectively. Male sex and anaplastic histology at recurrence were associated with decreased OS and FFP on multivariate analysis. Distant-only failure treated with CSI-RT2 was independently associated with improved OS compared with individuals with local failure treated with focal RT2 (hazard ratio 0.37; 95{\%} confidence interval 0.16-0.87). Among individuals experiencing any distant failure after RT1, gain of chromosome 1q was adversely associated with poorer OS (hazard ratio 3.5; 95{\%} confidence interval 1.1-10.6). No distant-only failures were observed in individuals with RT1 local failure who received CSI-RT2 (n=10). The 10-year cumulative incidence of grade ≥3 radiation necrosis after RT2 was 7.9{\%}. Conclusions: Reirradiation for relapsed pediatric ependymoma was well tolerated by most patients and resulted in long-term survival in a subset of patients. The best results were observed in patients who experienced distant-only failure after RT1 and were treated with CSI as part of RT2, without anaplasia at recurrence. The option of reirradiation should be discussed with patients who develop recurrent ependymoma.",
author = "Tsang, {Derek S.} and Elizabeth Burghen and Paul Klimo and Frederick Boop and Ellison, {David W.} and Merchant, {Thomas E.}",
year = "2018",
month = "2",
day = "1",
doi = "10.1016/j.ijrobp.2017.10.002",
language = "English (US)",
volume = "100",
pages = "507--515",
journal = "International Journal of Radiation Oncology Biology Physics",
issn = "0360-3016",
publisher = "Elsevier Inc.",
number = "2",

}

TY - JOUR

T1 - Outcomes After Reirradiation for Recurrent Pediatric Intracranial Ependymoma

AU - Tsang, Derek S.

AU - Burghen, Elizabeth

AU - Klimo, Paul

AU - Boop, Frederick

AU - Ellison, David W.

AU - Merchant, Thomas E.

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Purpose: To determine the long-term outcomes and the optimal dose and volume for reirradiation of recurrent pediatric ependymoma. Methods and Materials: Patients with recurrent ependymoma treated with a second course of fractionated radiation therapy (RT2) were reviewed retrospectively. Eligible patients had localized, intracranial ependymoma at initial diagnosis that was treated with focal radiation (RT1) without craniospinal irradiation (CSI) and were aged ≤21 years at the time of RT2. The median doses of RT1, focal RT2, and CSI-RT2 were 59.4, 54, and 39.6 Gy, respectively. The primary endpoint, overall survival (OS), was measured from the first day of RT2. Results: We included 101 patients in the study. The median interval between RT1 and RT2 was 26.8 months (interquartile range, 18.0-43.1). The median durations of OS and freedom from progression (FFP) were 75.1 and 27.3 months, respectively. Male sex and anaplastic histology at recurrence were associated with decreased OS and FFP on multivariate analysis. Distant-only failure treated with CSI-RT2 was independently associated with improved OS compared with individuals with local failure treated with focal RT2 (hazard ratio 0.37; 95% confidence interval 0.16-0.87). Among individuals experiencing any distant failure after RT1, gain of chromosome 1q was adversely associated with poorer OS (hazard ratio 3.5; 95% confidence interval 1.1-10.6). No distant-only failures were observed in individuals with RT1 local failure who received CSI-RT2 (n=10). The 10-year cumulative incidence of grade ≥3 radiation necrosis after RT2 was 7.9%. Conclusions: Reirradiation for relapsed pediatric ependymoma was well tolerated by most patients and resulted in long-term survival in a subset of patients. The best results were observed in patients who experienced distant-only failure after RT1 and were treated with CSI as part of RT2, without anaplasia at recurrence. The option of reirradiation should be discussed with patients who develop recurrent ependymoma.

AB - Purpose: To determine the long-term outcomes and the optimal dose and volume for reirradiation of recurrent pediatric ependymoma. Methods and Materials: Patients with recurrent ependymoma treated with a second course of fractionated radiation therapy (RT2) were reviewed retrospectively. Eligible patients had localized, intracranial ependymoma at initial diagnosis that was treated with focal radiation (RT1) without craniospinal irradiation (CSI) and were aged ≤21 years at the time of RT2. The median doses of RT1, focal RT2, and CSI-RT2 were 59.4, 54, and 39.6 Gy, respectively. The primary endpoint, overall survival (OS), was measured from the first day of RT2. Results: We included 101 patients in the study. The median interval between RT1 and RT2 was 26.8 months (interquartile range, 18.0-43.1). The median durations of OS and freedom from progression (FFP) were 75.1 and 27.3 months, respectively. Male sex and anaplastic histology at recurrence were associated with decreased OS and FFP on multivariate analysis. Distant-only failure treated with CSI-RT2 was independently associated with improved OS compared with individuals with local failure treated with focal RT2 (hazard ratio 0.37; 95% confidence interval 0.16-0.87). Among individuals experiencing any distant failure after RT1, gain of chromosome 1q was adversely associated with poorer OS (hazard ratio 3.5; 95% confidence interval 1.1-10.6). No distant-only failures were observed in individuals with RT1 local failure who received CSI-RT2 (n=10). The 10-year cumulative incidence of grade ≥3 radiation necrosis after RT2 was 7.9%. Conclusions: Reirradiation for relapsed pediatric ependymoma was well tolerated by most patients and resulted in long-term survival in a subset of patients. The best results were observed in patients who experienced distant-only failure after RT1 and were treated with CSI as part of RT2, without anaplasia at recurrence. The option of reirradiation should be discussed with patients who develop recurrent ependymoma.

UR - http://www.scopus.com/inward/record.url?scp=85041304829&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85041304829&partnerID=8YFLogxK

U2 - 10.1016/j.ijrobp.2017.10.002

DO - 10.1016/j.ijrobp.2017.10.002

M3 - Article

VL - 100

SP - 507

EP - 515

JO - International Journal of Radiation Oncology Biology Physics

JF - International Journal of Radiation Oncology Biology Physics

SN - 0360-3016

IS - 2

ER -