Intensity-Modulated Radiation Therapy in Childhood Ependymoma

Thomas M. Schroeder, Murali Chintagumpala, M. Fatih Okcu, J. Kam Chiu, Bin S. Teh, Shiao Y. Woo, Arnold C. Paulino

Research output: Contribution to journalArticle

40 Scopus citations

Abstract

Purpose: To determine the patterns of failure after intensity-modulated radiation therapy (IMRT) for localized intracranial ependymoma. Methods and Materials: From 1994 to 2005, 22 children with pathologically proven, localized, intracranial ependymoma were treated with adjuvant IMRT. Of the patients, 12 (55%) had an infratentorial tumor and 14 (64%) had anaplastic histology. Five patients had a subtotal resection (STR), as evidenced by postoperative magnetic resonance imaging. The clinical target volume encompassed the tumor bed and any residual disease plus margin (median dose 54 Gy). Median follow-up for surviving patients was 39.8 months. Results: The 3-year overall survival rate was 87% ± 9%. The 3-year local control rate was 68% ± 12%. There were six local recurrences, all in the high-dose region of the treatment field. Median time to recurrence was 21.7 months. Of the 5 STR patients, 4 experienced recurrence and 3 died. Patients with a gross total resection had significantly better local control (p = 0.024) and overall survival (p = 0.008) than those with an STR. At last follow-up, no patient had developed visual loss, brain necrosis, myelitis, or a second malignancy. Conclusions: Treatment with IMRT provides local control and survival rates comparable with those in historic publications using larger treatment volumes. All failures were within the high-dose region, suggesting that IMRT does not diminish local control. The degree of surgical resection was shown to be significant for local control and survival.

Original languageEnglish (US)
Pages (from-to)987-993
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume71
Issue number4
DOIs
StatePublished - Jul 15 2008

Keywords

  • Ependymoma
  • Intensity-modulated radiation therapy
  • Intracranial
  • Pediatric
  • Radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

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