ArticleJournal of neuro-oncology2020
Extent of re-excision, sequence/timing of salvage re-irradiation, and disease-free interval impact upon clinical outcomes in recurrent/progressive ependymoma.
Article in Journal of neuro-oncology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Reirradiation of recurrent brain tumors: a review by the ESTRO CNS Focus Group.Clinical and translational radiation oncology · 2027Review
- Validation of Combs prognostic scoring system in Indian recurrent glioma patients treated with re-radiation.Radiation oncology journal · 2024Article
- The evolving role of reirradiation in the management of recurrent brain tumors.Journal of neuro-oncology · 2023Review
- Application of Drug Testing Platforms in Circulating Tumor Cells and Validation of a Patient-Derived Xenograft Mouse Model in Patient with Primary Intracranial Ependymomas with Extraneural Metastases.Diagnostics (Basel, Switzerland) · 2023Article
- Epigenetic Alterations of Repeated Relapses in Patient-matched Childhood Ependymomas.Nature communications · 2022Article
- Treatment and outcome of pediatric intracranial ependymoma after first relapse.Journal of neuro-oncology · 2022Article
- Systemic chemotherapy of pediatric recurrent ependymomas: results from the German HIT-REZ studies.Journal of neuro-oncology · 2021Article
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Authors and funding
13 authors.
Funding
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Abstract
purposeTo report clinical outcomes of salvage re-irradiation (re-RT) in recurrent/progressive ependymoma.
methodsMedical records of patients treated with curative-intent re-RT as multi-modality management for recurrent/progressive ependymoma were analyzed retrospectively. The linear-quadratic model was used to provide estimates of biologically effective dose (BED) of irradiation using an α/β value of 2 for late CNS toxicity for each course of irradiation and summated to derive cumulative BED without correcting for the assumed recovery.
resultsA total of 55 patients (median age 10 years at index diagnosis) treated with curative-intent re-RT between 2010 and 2018 were included. Median time to first recurrence was 29 months with an inter-quartile range (IQR) of 16-64 months. Majority (n = 46, 84%) of patients underwent surgical re-excision of recurrent disease. Median interval from first course of irradiation (RT1) to second course (RT2) was 35 months (IQR = 26-66 months) with a median re-RT dose of 54 Gy in 30 fractions (range 40-60 Gy), resulting in median cumulative equivalent dose in 2 Gy fraction (EQD2) of 106.2 Gy (range 92.4-117.6 Gy). Volume of re-RT was based on location and pattern of relapse, comprising uni-focal (n = 49, 89%), multi-focal (n = 3, 5.5%), or craniospinal irradiation (CSI) in 3 (5.5%) patients respectively. Thirty-six (66%) patients received platinum-based salvage chemotherapy either before or after RT2. At a median follow up of 37 months (range 6-80 months), the Kaplan-Meier estimates of 3-year progression-free survival (PFS) and overall survival (OS) for the entire study cohort were 40% and 51% respectively. Gross total resection at recurrence; early salvage re-RT (prior to chemotherapy, if any); and longer (> 2 years) disease-free interval (DFI) were associated with better survival outcomes. Salvage re-RT was generally well tolerated with only 3 (5.5%) patients developing symptomatic radiation necrosis necessitating corticosteroids.
conclusionExtent of re-excision, sequence/timing of re-RT, and DFI impact upon outcomes in curative-intent, multi-modality salvage therapy for recurrent ependymoma.
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