ANAPLASTIC EPENDYMOMA - TREATMENT OF PEDIATRIC-PATIENTS WITH OR WITHOUT CRANIOSPINAL RADIATION-THERAPY

The authors conducted a retrospective review of the clinical and treat ment characteristics and outcomes in 28 pediatric patients with anapla stic ependymoma treated with radiation therapy since the advent of com puterized tomography (CT) (1978-1994). Twelve patients received cranio spinal irradiation followed by a boost to the primary site, two receiv ed whole-brain radiation therapy followed by a boost to the primary si te, and the remaining 14 were treated with focal radiation therapy. Th e mean dose to the primary site was 5486 cGy. With a median follow-up period of 86 months for the 14 surviving patients (range 31-201 months ), the median disease-free survival, measured from the date of diagnos is to the time of recurrence after radiation therapy, was 40 months. T he median disease-free survival measured from the start of radiation t herapy was 32 months. The median overall survival rate has not been re ached and the actuarial estimates of overall survival rates at 5 and 1 0 years were 56% and 38%, respectively. According to univariate analys is, the disease-free survival rate was significantly improved (p < 0.0 1) in patients who underwent a gross-total resection at diagnosis. Ove rall survival rates were negatively influenced by treatment with crani ospinal and whole-brain irradiation. As calculated by multivariate ana lysis, increasing dosage to the primary site (p < 0.05), infratentoria l location (p < 0.01), and gross-total resections (p < 0.02) resulted in the longest disease-free survival times. All 19 patients in whom tr eatment failed after radiation therapy suffered a recurrence at the pr imary site. In addition, one of these patients experienced subarachnoi d dissemination. Radiation treatment recommendations for patients with ependymoma have been based on the tumor's location, perceived risk fo r dissemination, and malignant propensity. The significance of anaplas tic histological classification is controversial. Differences in the d isease-free and overall survival rates have been demonstrated between ependymomas and anaplastic ependymomas treated in the pre-CT era. The results of this study show that there is no benefit from craniospinal irradiation in this group of patients.