INTRACRANIAL EPENDYMOMAS IN CHILDREN - A CRITICAL-REVIEW OF PROGNOSTIC FACTORS AND A PLEA FOR COOPERATION

Background. Current controversies in pediatric intracranial ependymoma include histologic categorization and management. Most of our knowled ge of this disease comes from single-institution reports. Methods. A l iterature search was done, covering the period 1976-1996. The aim of t his review is to analyze the prognostic factors reported in the litera ture over the last 20 years. Results. Forty-five series were reviewed, including more than 1,400 children. The largest series reported on 92 patients, and the accrual rate ranged from 0.32-12 patients per year. None of the prognostic factors reported achieved a consensus througho ut the different series. Histology remains a major issue, and the rang e in the incidence of anaplastic ependymo mas (7-89%) highlights the d ifficulty in agreeing on a histological grading system. The role of su rgery on the outcome seems to be determinant. Recent series based on h omogeneous imaging-documented extents of resection strongly support th e benefit of postoperative radiotherapy. The lack of a proven, effecti ve chemotherapy regimen precludes its use except in prospective pilot studies. Conclusions, Limited information is available from single-ins titution reports in ependymoma. Only large national or international s tudies can provide enough information to allow a multivariate analysis of the prognostic factors, and thus lead to new therapeutic proposals . (C) 1998 Wiley-Liss, Inc.