paediatrics Brussels 17

1595 / 1708

Phase II trial
Role of radiotherapy in anaplastic ependymoma in children
under age of 3 years: Results of the prospective German
brain tumor trials HIT-SKK 87 and 92*
Beate Timmermanna,b, *, Rolf-Dieter Kortmanna, Joachim Ku¨hlc , Stefan Rutkowskic,
Karin Dieckmanne, Christof Meisnerd, Michael Bamberg a
aDepartment of Radiooncology, University of Tu¨bingen, Tu¨bingen, Germany, bDivision of Radiation Medicine, Paul Scherrer Institute, Villigen,
Switzerland, cChildren’s Hospital, University of Wu¨rzburg, Wu¨rzburg, Germany, dInstitute of Medical Information Processing, University of
Tu¨bingen, Tu¨bingen, Germany, eDepartment of Radiooncology, General Hospital, Vienna, Austria
Abstract
Background and purpose: To evaluate the outcome of very young children with anaplastic ependymoma after delayed
or omitted radiotherapy (RT).
Materials and methods : Children under age of 3 years with anaplastic ependymoma were enrolled in the HIT-SKK 87
trial from 1987. After surgery, low-risk patients (R0, M0) received maintenance chemotherapy until elective RT at age of
three. In high-risk patients (RC, M C) intensive induction chemotherapy was followed by maintenance chemotherapy and
subsequently delayed RT. If there was, progression radiotherapy started immediately. In the HIT-SKK 92, trial MTX-based
chemotherapy was applied. RT was administered in non-responders only.
Results: Thirty-four children with anaplastic ependymoma were eligible (age 1.0–33.0 months). All children received
chemotherapy. In 13 children, no RT was administered. Preventive RT after chemotherapy was given in nine, and salvage
RT in 12 children. OS and PFS rates after 3-year were 55.9 and 27.3%, respectively. Twenty-five children relapsed.
Positive impact on survival was observed in children with higher age, M0-stage, complete resection, and treatment with
radiotherapy. Without RT only 3/13, children survived.
Conclusion: Delaying RT jeopardizes survival even after intensive chemotherapy. Predominant site of failure is the
primary tumor site. RT of the neuraxis should be omitted in localized disease.
q 2006 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 77 (2005) 278–285.
Keywords: Very young children; Ependymomas; Radiation therapy; Chemotherapy
Ependymomas comprise between 5 and 10% of childhood
brain tumors The peak incidence is in the first 3 years of
life, where ependymoma account for up to 30% of childhood
brain tumors . In children, therapy requires a careful
balance between toxicity and efficacy. In younger children,
the developing brain is very sensitive to any insult. This may
lead to severe late sequelae On the
other hand, the prognosis in very young children is
particularly poor
Many attempts have been made to increase survival while
reducing adverse side effects. Surgical resection of brain
tumors in babies and infants is often difficult . The risk of
side effects of radiotherapy correlates inversely to the age of
the child . In the past postoperative radiotherapy of
the whole central nervous system was standard treatment
for ependymoma In 1985, van Eys et al. reported the
use of postoperative chemotherapy to avoid radiotherapy for
infants Even though their results were not very
promising, many study groups started to delay radiation
therapy by early administration of chemotherapy.
We present an analysis of infants and babies enrolled in
prospective trials with postoperative chemotherapy. The
purpose of the report is to present the disease control results
for the very young children treated prospectively with
postoperative chemotherapy in an effort to delay or avoid
irradiation.
Materials and methods
In 1987, the German Pediatric Society for Hematology and
Oncology (GPOH) initiated a cooperative multi-institutional
0167-8140/$ - see front matter q 2006 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.radonc.2005.10.016
* Presented at ECCO 12, Copenhagen, Denmark, 21–25.09.03.
Radiotherapy and Oncology 77 (2005) 278–285