1519 / 1708
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.
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
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
Table 3. Clinical and initial treatment information for study patients
Patient
Reirradiation
volume
IT (or) ST
Initial
tumor Grade Chemotheraphy
Surgery
extent
RT/
age (Y)
Dose
(Gy)
Pattern of
Failure
POF
1
SRS
ST
AEP
Yes
GTR
1.1 48 (30.4 Gy CSI)
Local
2
SRS
IT
EP
Yes
GTR
4.2
50.4
Local
3
SRS
IT
EP
Yes
NTR
2.8
60.4
Local
4
SRS
IT
EP
No
NTR
6.6
69.6
Local
5
SRS
IT
EP
No
GTR
1.8
50.0
Local
6
SRS
IT
AEP
No
NTR
2.7 54(+9 +Gy SRS)
Metastatic
7
Local
IT
FAEP
Yes
STR
3.9 40(+8 +Gy SRS)
Local
8
Local
IT
EP
No
GTR
3.4
59.4
Local
9
Local
ST
AEP
No
GTR
6.3
55.8
Local
10
Local
IT
AEP
Yes
NTR
9.7
59.4
Local
11
Local
IT
AEP
No
GTR
1.9
59.4
Local
12
Local
IT
FAEP
Yes
NTR
4.6
59.4
Local
13
Local
ST
AEP
Yes
GTR
3.4
50.4
Local
14
Local
IT
AEP
Yes
STR
1.4
55.8
Local
15
Local
IT
AEP
No
GTR
2.0
59.4
Local
16
Local
IT
EP
Yes
GTR
1.7
59.4
Local
17
Local
IT
FAEP
No
GTR
1.5
59.4
Local
18
Local
IT
AEP
No
GTR
3.1
69.6
Local
19
Local
IT
EP
No
GTR
7.1
54.0
Local
20
CSI
ST
AEP
Yes
GTR 13.2
54.0
Combined
21
CSI
IT
EP
No
STR
4.7 59.4 (+15Gy SRS)
Combined
22
CSI
ST
AEP
No
GTR 15.3
59.4
Combined
23
CSI
IT
EP
Yes
STR
2.0
37.8
Combined
24
CSI
ST
FAEP
No
GTR
5.9
54.0
Local
25
CSI
IT
EP
Yes
NTR
4.2
59.4
Local
26
CSI
IT
FAEP
Yes
GTR
2.2
59.4
Local
27
CSI
IT
AEP
No
GTR
5.1
59.4
Metastatic
28
CSI
IT
FAEP
No
GTR
4.8
59.4
Metastatic
29
CSI
IT
AEP
No
GTR
2.9
59.4
Metastatic
30
CSI
IT
FAEP
No
GTR
2.3
59.4
Metastatic
31
CSI
IT
FAEP
No
GTR
3.1
59.4
Metastatic
32
CSI
ST
AEP
Yes
GTR
7.4
59.4
Metastatic
33
CSI
IT
AEP
No
GTR
2.3
59.4
Metastatic
34
CSI
IT
AEP
No
GTR
2.8
59.4
Metastatic
35
CSI
IT
AEP
Yes
NTR 11.2
59.4
Metastatic
36
CSI
IT
EP
No
GTR
1.4
59.4
Metastatic
37
CSI
ST
AEP
No
GTR
6.6
54.0
Metastatic
38
CSI
IT
EP
Yes
STR
3.3
59.4
Metastatic
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.
Ependymoma reirradiation
d
T. E. M
ERCHANT
et al
.
93