Intracranial ependymomas in childhood - A retrospective review of sixty-two children

Of the 818 tumours of the central nervous system diagnosed between 1972 and 1991, 62 patients (35 males and 27 females) with histopathologically confi rmed ependymomas were treated and followed-up at the Children's Hospital of Hacettepe University during that period. The median age was 6 years (range 1-17 years). Headache, nausea and vomiting were the most frequent symptoms ; papilledema was the most common sign in our patients. Tumour sites were i n the posterior fossa in 47 patients and supratentorial in 15 patients. All patients underwent surgery. Gross- total resection was performed in 27 pat ients, subtotal resection in 32 patients and biopsy in the remaining 3 pati ents. Initially, 53 patients were given postoperative radiotherapy. Four pa tients did not receive radiotherapy because of their young age, whereas fiv e patients died prior to starting radiotherapy. Two slightly different type s of chemotherapy protocols were applied for an average of one year in 47 p atients. Event-free and overall survival rates at 10 years were 36% and 50% , respectively. Twenty children suffered relapse 4 to 55 months after diagn osis (median 16 months). Relapses were distant in 3 cases and local in 17. Age was the only statistically significant prognostic factor, patients youn ger than 5 years of age having a poorer outcome. Sex, histopathologic type, localization of the tumour, extent of surgery, and chemotherapy did not in fluence the prognosis in our study. Because the majority of recurrences wer e local, better local tumour control is required. New treatment strategies should be developed in order to improve local control.