TY - JOUR
T1 - Final results of the second prospective AIEOP protocol for pediatric intracranial ependymoma
AU - Massimino, Maura
AU - Miceli, Rosalba
AU - Giangaspero, Felice
AU - Boschetti, Luna
AU - Modena, Piergiorgio
AU - Antonelli, Manila
AU - Ferroli, Paolo
AU - Bertin, Daniele
AU - Pecori, Emilia
AU - Valentini, Laura Grazia
AU - Biassoni, Veronica
AU - Garre', Maria Luisa
AU - Schiavello, Elisabetta
AU - Sardi, Iacopo
AU - Cama, Armando
AU - Viscardi, E.
AU - Scarzello, Giovanni
AU - Scoccianti, Silvia
AU - Mascarin, Maurizio
AU - Quaglietta, Lucia
AU - Cinalli, Giuseppe
AU - Diletto, Barbara
AU - Genitori, Lorenzo
AU - Peretta, Paola
AU - Mussano, Anna
AU - Buccoliero, Annamaria
AU - Calareso, Giuseppina
AU - Barra, Salvina
AU - Mastronuzzi, Angela
AU - Giussani, Carlo
AU - Marras, Carlo Efisio
AU - Balter, R.
AU - Bertolini, P.
AU - Giombelli, E.
AU - La Spina, Milena
AU - Buttarelli, Francesca Romana
AU - Pollo, Bianca
AU - Gandola, Lorenza
PY - 2016/10/1
Y1 - 2016/10/1
N2 - Background This prospective study stratified patients by surgical resection (complete = NED vs incomplete = ED) and centrally reviewed histology (World Health Organization [WHO] grade II vs III). Methods WHO grade II/NED patients received focal radiotherapy (RT) up to 59.4 Gy with 1.8 Gy/day. Grade III/NED received 4 courses of VEC (vincristine, etoposide, cyclophosphamide) after RT. ED patients received 1-4 VEC courses, second-look surgery, and 59.4 Gy followed by an 8-Gy boost in 2 fractions on still measurable residue. NED children aged 1-3 years with grade II tumors could receive 6 VEC courses alone. Results From January 2002 to December 2014, one hundred sixty consecutive children entered the protocol (median age, 4.9 y; males, 100). Follow-up was a median of 67 months. An infratentorial origin was identified in 110 cases. After surgery, 110 patients were NED, and 84 had grade III disease. Multiple resections were performed in 46/160 children (28.8%). A boost was given to 24/40 ED patients achieving progression-free survival (PFS) and overall survival (OS) rates of 58.1% and 68.7%, respectively, in this poor prognosis subgroup. For the whole series, 5-year PFS and OS rates were 65.4% and 81.1%, with no toxic deaths. On multivariable analysis, NED status and grade II were favorable for OS, and for PFS grade II remained favorable. Conclusions In a multicenter collaboration, this trial accrued the highest number of patients published so far, and results are comparable to the best single-institution series. The RT boost, when feasible, seemed effective in improving prognosis. Even after multiple procedures, complete resection confirmed its prognostic strength, along with tumor grade. Biological parameters emerging in this series will be the object of future correlatives and reports.
AB - Background This prospective study stratified patients by surgical resection (complete = NED vs incomplete = ED) and centrally reviewed histology (World Health Organization [WHO] grade II vs III). Methods WHO grade II/NED patients received focal radiotherapy (RT) up to 59.4 Gy with 1.8 Gy/day. Grade III/NED received 4 courses of VEC (vincristine, etoposide, cyclophosphamide) after RT. ED patients received 1-4 VEC courses, second-look surgery, and 59.4 Gy followed by an 8-Gy boost in 2 fractions on still measurable residue. NED children aged 1-3 years with grade II tumors could receive 6 VEC courses alone. Results From January 2002 to December 2014, one hundred sixty consecutive children entered the protocol (median age, 4.9 y; males, 100). Follow-up was a median of 67 months. An infratentorial origin was identified in 110 cases. After surgery, 110 patients were NED, and 84 had grade III disease. Multiple resections were performed in 46/160 children (28.8%). A boost was given to 24/40 ED patients achieving progression-free survival (PFS) and overall survival (OS) rates of 58.1% and 68.7%, respectively, in this poor prognosis subgroup. For the whole series, 5-year PFS and OS rates were 65.4% and 81.1%, with no toxic deaths. On multivariable analysis, NED status and grade II were favorable for OS, and for PFS grade II remained favorable. Conclusions In a multicenter collaboration, this trial accrued the highest number of patients published so far, and results are comparable to the best single-institution series. The RT boost, when feasible, seemed effective in improving prognosis. Even after multiple procedures, complete resection confirmed its prognostic strength, along with tumor grade. Biological parameters emerging in this series will be the object of future correlatives and reports.
KW - boost
KW - ependymoma
KW - grade
KW - prognosis
KW - surgery
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U2 - 10.1093/neuonc/now108
DO - 10.1093/neuonc/now108
M3 - Article
VL - 18
SP - 1451
EP - 1460
JO - Neuro-Oncology
JF - Neuro-Oncology
SN - 1522-8517
IS - 10
ER -