1585 / 1708
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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