paediatrics Brussels 17

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Taylor

institutions. However, a multi-institutional series has been reported from the German HIT group [18]. In this series of 55 patients, supratentorial tumours received 54 Gy local RT and infratentorial tumours received CSRT 35.2 Gy in 1.6 Gy fractions with a local 20 Gy boost. All patients received chemotherapy. Three year OS was 75.6%. The extent of resection was significant, with a 3-year PFS of 83.3% for completely resected compared with 38.5% for incompletely resected tumours. Overall 40 patients had CSRT. Of 25 relapses 20 were local, 3 distant and 2 local þ distant. As with other studies [19,20], the predominant pattern of relapse was local and anaplastic EP, although associated with a worse outcome should probably be treated according to the same guidelines as grade II EP. CONCLUSIONS The data on RT dose response relationships in the literature on the management of EP are difficult to interpret. The majority of studies have shown a major impact of extent of resection and histology on outcome. There have been inadequate patient numbers to perform reliable multivariate analyses. There is some evidence of dose response relationship from < 45 up to > 50 Gy. In most series the predominant pattern of relapse in all series is local, even after gross total resection and post-operative RT. There is no evidence of benefit for extended field or craniospinal RT. The priority for future studies is to maximise the probability of local tumour control. Mea- sures might include increasing the proportion with complete resection, possibly with use of chemotherapy and ‘second look surgery’ for those with initial incomplete resection. It may also be possible to enhance the benefit for RT, by dose escalation with conventionally fractionated conformal RT. This will be the subject of the planned Children’s Oncology Group study. The role of HFRT may justify further evaluation and results of completed studies are awaited.

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