PROGNOSTIC FACTORS IN INFANTS AND VERY YOUNG-CHILDREN WITH INTRACRANIAL EPENDYMOMAS

The Pediatric Oncology Group (1986-1990) conducted a study in which 48 children <3 years of age with intracranial ependymomas were treated w ith prolonged postoperative chemotherapy (CT) and delayed RT. Thirty-o ne children, 0-23 months of age at diagnosis (Gp A) received 2 years o f CT followed by RT; while 17 children, 24-36 months of age at diagnos is (Gp B) received CT for 1 year followed by radiation. One-year survi vals were 87% (Gp A) and 94% (Gp B) and 2-year survivals were 67% (Gp A) and 82% (Gp B). In subsequent years a significant divergence in sur vivals according to age has been noted (p = 0.04). Five-year survivals were 25.7% (Gp A) vs. 63.3% (Gp B). The curves began to diverge 1 yea r following diagnosis. Other than age, the only significant prognostic factor was degree of surgical resection: 5-year survivals were 66% (t otal resection) vs. 25% (subtotal resection). Neither the presence of metastases, degree of anaplasia nor the degree of surgical resection v aried significantly according to age at diagnosis. The most likely rea son for the difference in survivals between the two age groups relates to the timing of radiation following CT, i.e., 1-year delay in childr en 24-36 months of age compared to a 2-year delay in children 0-23 mon ths of age. An alternative but less likely hypothesis is that ependymo mas in the younger children have a more aggressive biology. In contras t, survivals in the 24- to 36-month group are much better than previou s reports in the literature suggesting that prolonged postoperative CT may allow both a delay in CRT as well as provide improved survivals. Based on these results, future treatment trials should emphasize maxim al surgical resection and a delay in radiation of no more than 1 year.