Conformal radiotherapy after surgery for paediatric ependymoma: a prospective study
Thomas E. Merchant,Chenghong Li,Xiaoping Xiong,Larry E. Kun,Frederic A. Boop,Robert A. Sanford +5 more
TL;DR: This treatment approach to include children under the age of 3 years with the aim of improving tumour control was extended and tumour grade, tumour location, ethnic origin, sex, age when undergoing conformal radiotherapy, total radiotherapy dose, number of surgical procedures, surgery extent, and preradiotherapy chemotherapy were considered.
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Abstract: Summary Background Therapy for ependymoma includes aggressive surgical intervention and radiotherapy administered by use of methods that keep the risk of side-effects to a minimum. We extended this treatment approach to include children under the age of 3 years with the aim of improving tumour control. Methods Between July 11, 1997, and Nov 18, 2007, 153 paediatric patients (median age 2·9 years [range 0·9–22·9 months]) with localised ependymoma were treated. 85 patients had anaplastic ependymoma; the tumours of 122 were located in the infratentorial region, and 35 had received previous chemotherapy. Patients received conformal radiotherapy after definitive surgery (125 patients had undergone gross total, 17 near total, and 11 subtotal resection). Doses of 59·4 Gy (n=131) or 54·0 Gy (n=22) were prescribed to a 10 mm margin around the target volume. Disease control, patterns of failure, and complications were recorded for patients followed over 10 years. Overall survival, event-free survival (EFS), cumulative incidence of local recurrences, and cumulative incidence of distant recurrences were assessed. Variables considered included tumour grade, tumour location, ethnic origin, sex, age when undergoing conformal radiotherapy, total radiotherapy dose, number of surgical procedures, surgery extent, and preradiotherapy chemotherapy. Findings After a median follow-up of 5·3 years (range 0·4–10·4), 23 patients had died and tumour progression noted in 36, including local (n=14), distant (n=15), and combined failure (n=7). 7-year local control, EFS, and overall survival were 87·3% (95% CI 77·5–97·1), 69·1% (56·9–81·3), and 81·0% (71·0–91·0), respectively. The cumulative incidences of local and distant failure were 16·3% (9·6–23·0) and 11·5% (5·9–17·1), respectively. In the 107 patients treated with immediate postoperative conformal radiotherapy (without delay or chemotherapy), 7-year local control, EFS, and overall survival were 88·7% (77·9–99·5), 76·9% (63·4–90·4), and 85·0% (74·2–95·8), respectively; the cumulative incidence of local and distant failure were 12·6% (5·1–20·1), and 8·6% (2·8–14·3), respectively. The incidence of secondary malignant brain tumour at 7 years was 2·3% (0–5·6) and brainstem necrosis 1·6% (0–4·0). Overall survival was affected by tumour grade (anaplastic vs differentiated: HR 3·98 [95% CI 1·51–10·48]; p=0·0052), extent of resection (gross total vs near total or subtotal: 0·16 [0·07–0·37]; p vs white: 3·0 [1·21–7·44]; p=0·018). EFS was affected by tumour grade (anaplastic vs differentiated: 2·52 [1·27–5·01]; p=0·008), extent of resection (gross total vs near total or subtotal: 0·20 [0·11–0·39]; p vs female: 2·19 [1·03–4·66]; p=0·042). Local failure was affected by extent of resection (gross total vs near total or subtotal: 0·16 [0·067–0·38]; p vs female: 3·85 [1·10–13·52]; p=0·035), and age ( vs ≥3 years: 3·25 [1·30–8·16]; p=0·012). Distant recurrence was only affected by tumour grade (anaplastic vs differentiated: 4·1 [1·2–14·0]; p=0·017). Interpretation Treatment of ependymoma should include surgery with the aim of gross-total resection and conformal, high-dose, postoperative irradiation. Future trials might consider treatment stratification based on sex and age. Funding American Cancer Society and American Lebanese Syrian Associated Charities (ALSAC).
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Neuro-oncological Disorders of the Cerebellum
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Ependymoma: Advances in Systems Treatment Strategies
Xiaoling Qiu,Zuqing Wu,HaoQun Xie,Shibei Wang,Qunying Yang,Chengcheng Guo,Xiaoling Qiu,Zuqing Wu,HaoQun Xie,Shibei Wang,Qunying Yang,Chengcheng Guo,Xiaoling Qiu,Zuqing Wu,HaoQun Xie,Shibei Wang,Qunying Yang,Chengcheng Guo +17 more
Immunohistochemical expression of cyclin D1 is higher in supratentorial ependymomas and predicts relapses in gross total resection cases
Fernanda Gonçalves de Andrade,Suely Kazue Nagahashi Marie,Miyuki Uno,Hamilton Matushita,M. Taricco,Manoel Jacobsen Teixeira,Sérgio Rosemberg,Sueli Mieko Oba-Shinjo +7 more
TL;DR: A stratified analysis demonstrated that cyclin D1 protein expression was strong in tumors with a supratentorial location, independent of the histological grade or age, and could be used as an immunohistochemical marker to guide follow‐up and treatment in ependymomas.
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TL;DR: Prognosis for recurrent ependymoma in adolescents is poor, with significant heterogeneity in outcomes.
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Edward L. Kaplan,Paul Meier +1 more
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A Proportional Hazards Model for the Subdistribution of a Competing Risk
Jason P. Fine,Robert Gray +1 more
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The Statistical Analysis of Failure Time Data.
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Regression models and life tables (with discussion
David Cox
- 01 Jan 1972
TL;DR: The drum mallets disclosed in this article are adjustable, by the percussion player, as to balance, overall weight, head characteristics and tone production of the mallet, whereby the adjustment can be readily obtained.
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Design and analysis of randomized clinical trials requiring prolonged observation of each patient. II. analysis and examples.
Richard Peto,M.C. Pike,P. Armitage,N. E. Breslow,David Cox,S V Howard,N Mantel,Klim McPherson,Julian Peto,Pete Smith +9 more
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