paediatrics Brussels 17

37.5% 17% for the eight patients who were 0 to 23

months of age and 87.5% 12% for the eight patients who

were 24 to 36 months old. Their findings suggested that the

poor survival estimates frequently reported for young chil-

dren were probably related to the delay in the administra-

tion of radiation therapy, although tumor location and

extent of resection were important cofactors.

Preirradiation chemotherapy was shown to marginally

effect PFS by univariate statistics in this report. The PFS

after radiation therapy has been shown to be shorter for

those treated with chemotherapy compared with those not

treated with chemotherapy.

42,43

In the prospective Pediatric

Oncology Group study,

those who received chemotherapy

for 2 years had a worse PFS when compared with those who

received chemotherapy for 1 year; however, because the

Pediatric Oncology Group study did not have a radiation

control arm, the effect seemed to be age-related. In our

study, we had a sufficient number of young patients who

did and did not receive chemotherapy so that we were able

to perform univariate and multivariate analyses to show

that age was not a factor and that preirradiation chemother-

apy affects PFS by univariate statistics. The marginal signif-

icance of this result leads us to believe that the 7-week

course of chemotherapy for incompletely resected patients

on the current Children’s Oncology Group study will not

compromise PFS.

The French Society of Pediatric Oncology conducted a

study to determine whether postoperative chemotherapy

and additional surgery at the completion of chemotherapy

or time of progression could replace radiation therapy as

treatment for ependymoma in 73 children younger than 5

years.

PFS estimates at 2 and 4 years were 33% and 22%,

respectively; 50%of patients experienced relapse during the

planned chemotherapy course. Radiation therapy was ulti-

mately delivered to 39 patients (53%), but nearly 72% of

patients with relapsed disease required further surgery and

irradiation. At the time of their report, 34 patients (47%)

had avoided irradiation, but only 11 were without evidence

of disease and remained at high risk of progression.

The median age of patients enrolled on the present

study was 2.85 years, and their outcome has raised further

questions about the necessity of chemotherapy and of ef-

forts to delay or avoid irradiation. On the basis of our

findings, the use of radiation therapy for pediatric patients

of all ages (1 to 21 years) has been adopted by investigators

from the Children’s Oncology Group. The current national

trial for pediatric patients with localized ependymoma uses

the targeting guidelines from this study and seeks to in-

crease the proportion of cases in which gross-total resection

is achieved, through the use of second surgery (Children’s

Oncology Group ACNS0121).

Authors’ Disclosures of Potential

Conflicts of Interest

The authors indicated no potential conflicts of interest.

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