Stereotactic radiosurgery for recurrent ependymoma

BACKGROUND. Patients with recurrent intracranial ependymomas were evaluated to assess local control, overall survival, and complications from stereota ctic radiosurgery (SRS). METHODS. Twelve patients (with a total of 17 tumors) with recurrent ependym oma underwent SRS. Local failure was defined as tumor progression within th e prescription isodose volume, and marginal failure was defined as tumor pr ogression adjacent to the SRS prescription isodose volume. Tumor progressio n away from the prescription volume was considered distant failure. Eleven of the 12 patients had undergone previous resection and external beam radia tion therapy (46-56 Grays [Gy]; median, 54 Gy) before radiosurgery, and 1 p atient had failure after complete resection alone. Age at SRS ranged from 5 -56 years (median, 29 years). Three patients were female. The marginal tumo r dose was 12-24 Gy (median, 18 Gy). One to 14 isocenters (median, 4 isocen ters) were utilized to irradiate volumes of 0.3-15.5 cm(3) (median, 3.2 cm( 3)). RESULTS. The duration of follow-up ranged from 2.5-60 months (median, 22.5 months). The median overall survival after SRS was 3.4 years (range, 1.4-5 years). In-field local control was achieved in 14 of the 17 tumor sites and estimated 3-year local control was 68%. There were two in-field failures a nd one marginal failure. Distant failure occurred in two patients. Two pati ents developed treatment-related complications after SRS. CONCLUSIONS. SRS provides good local tumor control for patients with recurr ent intracranial ependymoma and map have a favorable impact on survival, SR S should be evaluated more extensively in the initial treatment of patients with ependymoma to minimize local failure after surgical management. (C) 2 000 American Cancer Society.