1584 / 1708
EP it would be worthwhile to include duration of RT
together with other RT parameters.
PATTERN OF RECURRENCE
Table II summarises the pattern of recurrence from
11 series. The pattern of recurrence is predominantly
local, with a low risk of leptomeningeal relapse.
RT VOLUME
In a literature review, there was no evidence to support
the use of extended field or craniospinal RT [7]. Further
series provide further confirmation of this view (Table III).
In one series, for eight patients presenting with leptome-
ningeal metastases a 5-year PFS of 37% was reported [5]
and in another series three of six [14] have remained
disease free after CSRT. The role of CSRT for patients
presenting with leptomeningeal relapse needs further
evaluation.
For patients treated by local RT there has been no
consistent recommendation for extent of CTV around the
PTV and margins for CTV have generally varied from
approximately 1 to 2 cm, and sometimes the whole post-
erior fossa. In a report from St. Jude’s Children’s Hospital,
64 patients with EP have been included in a study of
conformal RT using a margin of 1 cm for CTVaround the
GTV [17]. With a follow-up of 17 months (range 3–
43 months) there have been six recurrences. Failure
occurred within the CTV for five patients including three
with concurrent leptomeningeal relapse. One patient
developed metastatic disease with no evidence of local
failure. In this series treatment of a CTV encompassing
1.0 cm of brain around the margin of resection and/or any
residual tumour on MR scan appeared to be safe. Whether
this guideline is suitable for determination of the CTV in
a multi-institutional setting will be the subject of the
planned COG study.
MANAGEMENT OF ANAPLASTIC EPENDYMOMA
The majority of series report a worse outcome for
anaplastic (WHO grade III) compared with WHO grade II
EP. The majority of these series are from single
TABLE II. Pattern of Recurrence
Series
Pattern of recurrence
Number of patients
Local
Distant
Local
þ
Distant
Goldwein
51
29 (56.9%)
1 (2.0%)
Vanuytsel
88
45 (51.1%)
2 (2.3%)
5 (5.7%)
Chiu
25
12 (48.0%)
2 (8.0%)
Rousseau
65
20 (30.8%)
10 (15.4%)
3 (4.6%)
Carrie
37
14 (37.8%)
4 (10.8%)
Pollack
37
17 (45.9%)
2 (5.4%)
Stuben
41
7 (17.1%)
7 (17.1%)
Schild
45 (incl spine)
(35%)
(13%)
McLaughlin
32
20 (62.5%)
1 (3.1%)
Paulino
52
17 (32.7%)
4 (7.7%)
Oya
48
20 (41.7%)
6 (12.5%)
TABLE III. Influence of Extent of RT Volume on Outcome
Author [reference]
Outcome
Local RT
Craniospinal RT
Goldwein et al., 1990 [6]
31% 5-Year PFS
27% 5-Year PFS
Vanuytsel et al., 1992 [7]
38% 5-Year PFS
46% 5-Year PFS
Chiu et al., 1992 [8]
1/12 Leptomeningeal relapses
0/7 Leptomeningeal relapses
Rousseau et al., 1994 [4]
40% 5-Year EFS
49% 5-Year EFS
Carrie et al., 1995 [9]
0/5 Relapses
7/11 Relapses
Pollack et al., 1995 [5]
70% 5-Year PFS
51% 5-Year PFS
Stuben et al., 1997 [10]
58% 5-Year PFS
45% 5-Year PFS
Schild et al., 1998 [11]
9% Leptomeningeal relapses
24% Leptomeningeal relapses
McLaughlin et al., 1998 [12]
1/17 Leptomeningeal relapses
0/15 Leptomeningeal relapses
Paulino et al., 2002 [13]
80.8% 5-Year OS
71.4% 5-Year OS
Oya et al., 2002 [14]
3/37 Leptomeningeal relapses
1/10 Leptomeningeal relapses
OS, overall survival; EFS, event-free survival; PFS, progression-free survival.
Radiotherapy Dose and Volume for Ependymoma
459