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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

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{at}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.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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