TY - JOUR
T1 - Pediatric intracranial ependymoma
T2 - correlating signs and symptoms at recurrence with outcome in the second prospective AIEOP protocol follow-up
AU - Massimino, Maura
AU - Barretta, Francesco
AU - Modena, Piergiorgio
AU - Giangaspero, Felice
AU - Chiapparini, Luisa
AU - Erbetta, Alessandra
AU - Boschetti, Luna
AU - Antonelli, Manila
AU - Ferroli, Paolo
AU - Bertin, Daniele
AU - Pecori, Emilia
AU - Biassoni, Veronica
AU - Garrè, Maria Luisa
AU - Schiavello, Elisabetta
AU - Sardi, Iacopo
AU - Viscardi, Elisabetta
AU - Scarzello, Giovanni
AU - Mascarin, Maurizio
AU - Quaglietta, Lucia
AU - Cinalli, Giuseppe
AU - Genitori, Lorenzo
AU - Peretta, Paola
AU - Mussano, Anna
AU - Barra, Salvina
AU - Mastronuzzi, Angela
AU - Giussani, Carlo
AU - Marras, Carlo Efisio
AU - Balter, Rita
AU - Bertolini, Patrizia
AU - Tornesello, Assunta
AU - La Spina, Milena
AU - Buttarelli, Francesca Romana
AU - Ruggiero, Antonio
AU - Caldarelli, Massimo
AU - Poggi, Geraldina
AU - Gandola, Lorenza
PY - 2018/8/14
Y1 - 2018/8/14
N2 - PURPOSE: The aims of patients' radiological surveillance are to: ascertain relapse; apply second-line therapy; accrue patients in phase 1/2 protocols if second-line therapy is not standardized/curative; and assess/treat iatrogenic effects. To lessen the emotional and socioeconomic burdens for patients and families, we ideally need to establish whether scheduled radiological surveillance gives patients a better outcome than waiting for symptoms and signs to appear.METHODS: We analyzed a prospective series of 160 newly-diagnosed and treated pediatric/adolescent patients with intracranial ependymoma, comparing patients with recurrent disease identified on scheduled MRI (the RECPT group; 34 cases) with those showing signs/symptoms of recurrent disease (the SYMPPT group; 16 cases). The median follow-up was 67 months.RESULTS: No significant differences emerged between the two groups in terms of gender, age, tumor grade/site, shunting, residual disease, or type of relapse (local, distant, or concomitant). The time to relapse (median 19 months; range 5-104) and the MRI follow-up intervals did not differ between the SYMPPT and RECPT groups. The presence of signs/symptoms was an unfavorable factor for overall survival (OS) after recurrence (5-year OS: 8% vs. 37%, p = 0.001). On multivariable analysis, an adjusted model confirmed a significantly worse OS in the SYMPPT than in the RECPT patients.CONCLUSIONS: Symptomatic relapses carried a significantly worse survival for ependymoma patients than recurrences detected by MRI alone. It would therefore be desirable to identify recurrences before symptoms develop. Radiological follow-up should be retained in ependymoma patient surveillance because there is a chance of salvage treatment for relapses found on MRI.
AB - PURPOSE: The aims of patients' radiological surveillance are to: ascertain relapse; apply second-line therapy; accrue patients in phase 1/2 protocols if second-line therapy is not standardized/curative; and assess/treat iatrogenic effects. To lessen the emotional and socioeconomic burdens for patients and families, we ideally need to establish whether scheduled radiological surveillance gives patients a better outcome than waiting for symptoms and signs to appear.METHODS: We analyzed a prospective series of 160 newly-diagnosed and treated pediatric/adolescent patients with intracranial ependymoma, comparing patients with recurrent disease identified on scheduled MRI (the RECPT group; 34 cases) with those showing signs/symptoms of recurrent disease (the SYMPPT group; 16 cases). The median follow-up was 67 months.RESULTS: No significant differences emerged between the two groups in terms of gender, age, tumor grade/site, shunting, residual disease, or type of relapse (local, distant, or concomitant). The time to relapse (median 19 months; range 5-104) and the MRI follow-up intervals did not differ between the SYMPPT and RECPT groups. The presence of signs/symptoms was an unfavorable factor for overall survival (OS) after recurrence (5-year OS: 8% vs. 37%, p = 0.001). On multivariable analysis, an adjusted model confirmed a significantly worse OS in the SYMPPT than in the RECPT patients.CONCLUSIONS: Symptomatic relapses carried a significantly worse survival for ependymoma patients than recurrences detected by MRI alone. It would therefore be desirable to identify recurrences before symptoms develop. Radiological follow-up should be retained in ependymoma patient surveillance because there is a chance of salvage treatment for relapses found on MRI.
U2 - 10.1007/s11060-018-2974-6
DO - 10.1007/s11060-018-2974-6
M3 - Article
C2 - 30109673
SP - 457
EP - 465
JO - Journal of Neuro-Oncology
JF - Journal of Neuro-Oncology
SN - 0167-594X
ER -