TY - JOUR
T1 - Outcome of infants and young children with newly diagnosed ependymoma treated on the "head Start" III prospective clinical trial
AU - Venkatramani, Rajkumar
AU - Ji, Lingyun
AU - Lasky, Joseph
AU - Haley, Kelley
AU - Judkins, Alexander
AU - Zhou, Shengmei
AU - Sposto, Richard
AU - Olshefski, Randal
AU - Garvin, James
AU - Tekautz, Tanya
AU - Kennedy, Gloria
AU - Rassekh, Shahrad Rod
AU - Moore, Theodore
AU - Gardner, Sharon
AU - Allen, Jeffrey
AU - Shore, Richard
AU - Moertel, Christopher
AU - Atlas, Mark
AU - Dhall, Girish
AU - Finlay, Jonathan
N1 - Funding Information:
Funding Alex’s Lemonade Stand Foundation; Pediatric Cancer Research Foundation; Soccer for Hope Foundation; Isabella Grace Jordan Fund.
PY - 2013/6
Y1 - 2013/6
N2 - This study investigates the outcome of children <10 years old with newly-diagnosed ependymoma treated on the prospective multinational "Head Start" III clinical trial. Between April 2004 and July 2009, 19 children with newly-diagnosed ependymoma were enrolled. All children were to receive five induction chemotherapy cycles followed by one consolidation cycle of myelo-ablative chemotherapy and autologous hematopoietic cell rescue. Children between 6 and 10 years of age or with residual tumor prior to consolidation were to receive irradiation thereafter. Median age of 19 children (8 female) was 20 months at diagnosis. Median follow up was 44 months. The primary site was infratentorial in 11 and supratentorial in 8 patients. Gross total resection was achieved in 10 patients. After induction chemotherapy, all three supratentorial ependymoma patients with residual disease achieved a complete response (CR), while only one of six infratentorial patients with residual disease achieved CR. Three infratentorial patients developed progressive disease during induction chemotherapy. All four infratentorial patients with residual disease who underwent autologous hematopoietic cell transplant, failed to achieve CR. Four patients received focal irradiation following chemotherapy. The 3-year event free survival (EFS) and overall survival (OS) for supratentorial ependymoma were 86 ± 13 % and 100 % respectively. The 3-year EFS and OS for infratentorial ependymoma were 27 ± 13 % and 73 ± 13 % respectively. The role of intensive induction and consolidation chemotherapy in deferring irradiation should be investigated further in children with supratentorial ependymoma with residual disease following surgery. This approach appears ineffective in children with infratentorial ependymoma in the absence of irradiation.
AB - This study investigates the outcome of children <10 years old with newly-diagnosed ependymoma treated on the prospective multinational "Head Start" III clinical trial. Between April 2004 and July 2009, 19 children with newly-diagnosed ependymoma were enrolled. All children were to receive five induction chemotherapy cycles followed by one consolidation cycle of myelo-ablative chemotherapy and autologous hematopoietic cell rescue. Children between 6 and 10 years of age or with residual tumor prior to consolidation were to receive irradiation thereafter. Median age of 19 children (8 female) was 20 months at diagnosis. Median follow up was 44 months. The primary site was infratentorial in 11 and supratentorial in 8 patients. Gross total resection was achieved in 10 patients. After induction chemotherapy, all three supratentorial ependymoma patients with residual disease achieved a complete response (CR), while only one of six infratentorial patients with residual disease achieved CR. Three infratentorial patients developed progressive disease during induction chemotherapy. All four infratentorial patients with residual disease who underwent autologous hematopoietic cell transplant, failed to achieve CR. Four patients received focal irradiation following chemotherapy. The 3-year event free survival (EFS) and overall survival (OS) for supratentorial ependymoma were 86 ± 13 % and 100 % respectively. The 3-year EFS and OS for infratentorial ependymoma were 27 ± 13 % and 73 ± 13 % respectively. The role of intensive induction and consolidation chemotherapy in deferring irradiation should be investigated further in children with supratentorial ependymoma with residual disease following surgery. This approach appears ineffective in children with infratentorial ependymoma in the absence of irradiation.
KW - Ependymoma
KW - Infratentorial
KW - Irradiation
KW - Supratentorial
KW - Surgery
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UR - http://www.scopus.com/inward/citedby.url?scp=84879109838&partnerID=8YFLogxK
U2 - 10.1007/s11060-013-1111-9
DO - 10.1007/s11060-013-1111-9
M3 - Article
C2 - 23508296
AN - SCOPUS:84879109838
SN - 0167-594X
VL - 113
SP - 285
EP - 291
JO - Journal of neuro-oncology
JF - Journal of neuro-oncology
IS - 2
ER -