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Ependymoma reirradiation d T. E. M ERCHANT et al .

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Table 3. Clinical and initial treatment information for study patients

Pattern of Failure POF

Reirradiation volume

Initial tumor Grade Chemotheraphy

Surgery extent

RT/ age (Y)

Dose (Gy)

Patient

IT (or) ST

1 2 3 4 5 6 7 8 9

SRS SRS SRS SRS SRS SRS

ST IT IT IT IT IT IT IT IT IT IT IT IT IT IT IT IT ST ST ST IT IT IT IT IT IT IT IT IT IT IT ST ST IT ST IT ST

AEP

Yes Yes Yes

GTR GTR NTR NTR GTR NTR STR GTR GTR NTR GTR NTR GTR STR GTR GTR GTR GTR GTR STR GTR NTR GTR GTR GTR GTR GTR GTR GTR GTR GTR GTR GTR STR STR

1.1 48 (30.4 Gy CSI)

Local Local Local Local Local Local Local Local Local Local Local Local Local Local Local Local Local Local

EP EP EP EP

4.2 2.8 6.6 1.8

50.4 60.4 69.6 50.0

No No No

AEP

2.7 54(+9 +Gy SRS) 3.9 40(+8 +Gy SRS)

Metastatic

Local Local Local Local Local Local Local Local Local Local Local Local Local

FAEP

Yes

EP

No No

3.4 6.3 9.7 1.9 4.6 3.4 1.4 2.0 1.7 1.5 3.1 7.1 2.0 5.9 4.2 2.2 5.1 4.8 2.9 2.3 3.1 7.4 2.3 2.8 1.4 6.6 3.3

59.4 55.8 59.4 59.4 59.4 50.4 55.8 59.4 59.4 59.4 69.6 54.0 54.0 59.4 37.8 54.0 59.4 59.4 59.4 59.4 59.4 59.4 59.4 59.4 59.4 59.4 59.4 59.4 54.0 59.4

AEP AEP AEP AEP AEP AEP FAEP

10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38

Yes

No

Yes Yes Yes

No

EP

Yes

FAEP

No No No

AEP

EP

CSI CSI CSI CSI CSI CSI CSI CSI CSI CSI CSI CSI CSI CSI CSI CSI CSI CSI CSI

AEP

Yes

GTR 13.2

Combined Combined Combined Combined

EP

No No

4.7 59.4 (+15Gy SRS)

AEP

GTR 15.3

EP

Yes

FAEP

No

Local Local Local

EP

Yes Yes

FAEP

AEP

No No No No No

Metastatic Metastatic Metastatic Metastatic Metastatic Metastatic Metastatic Metastatic Metastatic Metastatic Metastatic Metastatic

FAEP

AEP

FAEP FAEP

AEP AEP AEP AEP

Yes

No No

Yes

NTR 11.2

EP

No No

AEP

IT

EP

Yes

Abbreviations: SRS = stereotactic radiosurgery; CSI = craniospinal irradiation; AEP = anaplastic ependymoma; EP = differentiated epen- dymoma; FAEP = ependymoma with focal anaplasia; GTR = gross total resection; NTR = near-total resection; STR = subtotal resection; RT = radiation therapy; IT = Infratentorial; ST = Supratentorial.

patients had no evidence of disease, with a median follow-up of 30 months (range, 2–136 months) after RT 2 . The PFS RT2 / PFS RT1 ratio was greater than unity for 5 of 10 patients.

Gy) and boost treatment (48.6 Gy metastasis; 45.4 Gy pri- mary site), and remains disease free more than 20 years later. Three patients with local failure received CSI for salvage therapy. One patient experienced relapse with metastatic dis- ease after 6 months and died despite subsequent chemother- apy. Follow-up for the remaining 2 patients was 13 and 14 months. There were 12 patients with metastatic failure after RT 1 who received CSI. All these patients were treated with meta- stasectomy of spinal, intracranial, or intraventricular disease. Resection was attempted for all lesions except isolated 3-mm spinal lesions in 2 patients that were considered too small to merit additional surgery. Three of 12 patients experienced progression at 19, 32, and 40 months. The remaining 9 pa- tients were followed up without disease progression for a me- dian of 22 months (range, 3–69 months). The PFS RT2 /PFS RT1

RT 2 : CSI Nineteen patients with previous combined ( n = 4), local ( n = 3), or metastatic ( n = 12) failure received CSI after ag- gressive attempts to resect locally recurrent and/or metastatic disease. Considering the 4 patients with a history of com- bined failure, 3 experienced relapse at 7, 8, and 9 months, and 1 was the longest survivor in this reirradiation series. The longest survivor experienced concurrent primary site re- lapse and metastasis to the thoracic spine after previous treat- ment with subtotal resection and 37.8 Gy. This patient underwent GTR at both sites in 1985, received CSI (35.2