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Ependymomas in babies and infants

longer delay of radiotherapy [8] . We observed a trend for better outcome in children older than 18 months. However, in accordance with Duffner et al. we also delayed radio- therapy for a longer period in younger children.

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Conclusion In ependymomas local control is the most important prognostic factor for treatment outcome. Therefore, optimization of local modalities seems to be most promising in order to improve prognosis. This may lead to more aggressive surgical procedures or second surgery in patients with residual disease. In localized disease, restriction of target volume to the primary tumor site only can achieve tumor control and, reduce the risk of long-term toxicity. Omission or long delay of radiotherapy should be avoided as it jeopardizes survival, even if intensive chemotherapy has been given. In very young children (e.g. less than 12–18 months), however, new approaches should be investigated in order to postpone focal radiotherapy. Monitoring of toxicity and late effects needs to become an essential part of all studies dealing with young children. * Corresponding author. Address: Beate Timmermann , Division of Radiation Medicine, Paul Scherrer Institute, CH-5232 Villigen-PSI, Switzerland. E-mail address: beate.timmermann@psi.ch References [1] Ater JL, van Eys J, Woo SY, Moore III B, Copeland DR, Bruner J. MOPP chemotherapy without irradiation as primary postsurgi- cal therapy for brain tumors in infants and young children. J Neurooncol 1997;32:243–52. [2] Carrie C, Mottolese C, Bouffet E, et al. Non-metastatic childhood ependymomas. Radiother Oncol 1995;36:101–6. [3] Chiu JK, Woo SY, Ater J, et al. Intracranial ependymoma in children: analysis of prognostic factors. J Neurooncol 1992;13: 283–90. [4] Di Marco A, Campostrini F, Pradella R, et al. Postoperative irradiation of brain ependymomas. Analysis of 33 cases. Acta Oncol 1988;27:261–7. [5] Duffner PK, Cohen ME. Treatment of brain tumors in babies and very young children. Pediatr Neurosci 1985;12:304–10. [6] Duffner PK, Cohen ME, Anderson SW, et al. Long-term effects of treatment on endocrine function in children with brain tumors. Ann Neurol 1983;14:528–32. [7] Duffner PK, Cohen ME, Myers MH, Heise HW. Survival of children with brain tumors: SEER Program, 1973–1980. Neurology 1986; 36:597–601. [8] Duffner PK, Horowitz ME, Krischer JP, et al. The treatment of malignant brain tumors in infants and very young children: an update of the Pediatric Oncology Group experience. Neuro- oncol 1999;1:152–61. [9] Duffner PK, Horowitz ME, Krischer JP, et al. Postoperative chemotherapy and delayed radiation in children less than three years of age with malignant brain tumors. N Engl J Med 1993; 328:1725–31. [10] Evans AE, Anderson JR, Lefkowitz-Boudreaux IB, Finlay JL. Adjuvant chemotherapy of childhood posterior fossa Received 14 April 2005; received in revised form 9 September 2005; accepted 4 October 2005