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Preliminary Results From a Phase II Trial of Conformal Radiation Therapy and
Evaluation of Radiation-Related CNS Effects for Pediatric Patients With
Localized Ependymoma
Thomas E. Merchant, Raymond K. Mulhern, Matthew
J. Krasin, Larry E. Kun, Tani Williams, Chenghong
Li, Xiaoping Xiong, Raja B. Khan, Robert
H. Lustig, Frederick A. Boop, Robert A. Sanford
From the Division of Radiation Oncology, Department of
Biostatistics, Division of Behavioral Medicine, St Jude Children's Research
Hospital; Semmes-Murphey Neurologic and Spine Institute; and Division of
Pediatric Neurosurgery, University of Tennessee, College of Medicine, Memphis,
TN; and Division of Pediatric Endocrinology, University of California San
Francisco, San Francisco, CA
Address reprint requests to Thomas E. Merchant, DO, PhD, Division of Radiation
Oncology, St Jude Children's Research Hospital, 332 N Lauderdale St, Memphis, TN
38105-2794; e-mail: thomas.merchant@stjude.org
Purpose. We conducted a phase II trial of conformal radiation therapy (CRT)
for localized childhood ependymoma to determine whether the
irradiated volume could be reduced to decrease CNS-related side
effects without diminishing the rate of disease control. Patients and Methods.
Between July 1997 and January 2003, 88 pediatric
patients (median age, 2.85 ± 4.5 years) received CRT in which doses
(59.4 Gy to 73 patients or 54.0 Gy after gross-total resection to
15 patients younger than 18 months) were administered to the gross
tumor volume and a margin of 10 mm.
Patients were categorized according
to extent of resection (underwent gross total resection, n = 74;
near-total resection, n = 6; subtotal resection, n = 8), prior
chemotherapy (n = 16), tumor grade (anaplastic, n = 35), and tumor
location (infratentorial, n = 68).
An age-appropriate neurocognitive
battery was administered before and serially after CRT. Results.
The median length of follow-up was 38.2 months (± 16.4 months);
the 3-year progression-free survival estimate was 74.7% ± 5.7%.
Local failure occurred in eight patients, distant failure in eight
patients, and both in four patients.
The cumulative incidence of
local failure as a component of failure at 3 years was 14.8% ± 4.0%.
Mean scores on all neurocognitive outcomes were stable and within
normal limits, with more than half the cohort tested at or beyond 24
months. Conclusion. Limited-volume irradiation achieves high rates of disease control
in pediatric patients with ependymoma and results in stable neurocognitive
outcomes.
Supported in part by Cancer Center Support grant No. CA21765
from the National Cancer Institute, by Research Project grant No.
RPG-99-252-01-CCE from the American Cancer Society, and by the
American Lebanese Syrian Associated Charities.
© 2004 American Society of Clinical Oncology
Source: http://www.jco.org/cgi/content/abstract/22/15/3156
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