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longer delay of radiotherapy . We observed a trend for
better outcome in children older than 18 months. However,
in accordance with Duffner et al. we also delayed radio-
therapy for a longer period in younger children.
Conclusion
In ependymomas local control is the most important
prognostic factor for treatment outcome. Therefore,
optimization of local modalities seems to be most promising
in order to improve prognosis. This may lead to more
aggressive surgical procedures or second surgery in patients
with residual disease. In localized disease, restriction of
target volume to the primary tumor site only can achieve
tumor control and, reduce the risk of long-term toxicity.
Omission or long delay of radiotherapy should be avoided as
it jeopardizes survival, even if intensive chemotherapy has
been given. In very young children (e.g. less than 12–18
months), however, new approaches should be investigated in
order to postpone focal radiotherapy. Monitoring of toxicity
and late effects needs to become an essential part of all
studies dealing with young children.
* Corresponding author. Address: Beate Timmermann, Division
of Radiation Medicine, Paul Scherrer Institute, CH-5232 Villigen-PSI,
Switzerland. E-mail address:
Received 14 April 2005; received in revised form 9 September 2005;
accepted 4 October 2005
References
[1] Ater JL, van Eys J, Woo SY, Moore III B, Copeland DR, Bruner J.
MOPP chemotherapy without irradiation as primary postsurgi-
cal therapy for brain tumors in infants and young children.
J Neurooncol 1997;32:243–52.
[2] Carrie C, Mottolese C, Bouffet E, et al. Non-metastatic
childhood ependymomas. Radiother Oncol 1995;36:101–6.
[3] Chiu JK, Woo SY, Ater J, et al. Intracranial ependymoma in
children: analysis of prognostic factors. J Neurooncol 1992;13:
283–90.
[4] Di Marco A, Campostrini F, Pradella R, et al. Postoperative
irradiation of brain ependymomas. Analysis of 33 cases. Acta
Oncol 1988;27:261–7.
[5] Duffner PK, Cohen ME. Treatment of brain tumors in babies and
very young children. Pediatr Neurosci 1985;12:304–10.
[6] Duffner PK, Cohen ME, Anderson SW, et al. Long-term effects of
treatment on endocrine function in children with brain tumors.
Ann Neurol 1983;14:528–32.
[7] Duffner PK, Cohen ME, Myers MH, Heise HW. Survival of children
with brain tumors: SEER Program, 1973–1980. Neurology 1986;
36:597–601.
[8] Duffner PK, Horowitz ME, Krischer JP, et al. The treatment of
malignant brain tumors in infants and very young children: an
update of the Pediatric Oncology Group experience. Neuro-
oncol 1999;1:152–61.
[9] Duffner PK, Horowitz ME, Krischer JP, et al. Postoperative
chemotherapy and delayed radiation in children less than three
years of age with malignant brain tumors. N Engl J Med 1993;
328:1725–31.
[10] Evans AE, Anderson JR, Lefkowitz-Boudreaux IB, Finlay JL.
Adjuvant chemotherapy of childhood posterior fossa
ependymoma: cranio-spinal irradiation with or without adju-
vant CCNU, vincristine, and prednisone: a Childrens Cancer
Group study. Med Pediatr Oncol 1996;27:8–14.
[11] Geyer JR. Infant brain tumors. Neurosurg Clin N Am 1992;3:
781–9.
[12] Geyer JR, Zeltzer PM, Boyett JM, et al. Survival of infants with
primitive neuroectodermal tumors or malignant ependymomas
of the CNS treated with eight drugs in 1 day: a report from the
Childrens Cancer Group. J Clin Oncol 1994;12:1607–15.
[13] Goldwein JW, Corn BW, Finlay JL, Packer RJ, Rorke LB, Schut L.
Is craniospinal irradiation required to cure children with
malignant (anaplastic) intracranial ependymomas? Cancer
1991;67:2766–71.
[14] Goldwein JW, Leahy JM, Packer RJ, et al. Intracranial
ependymomas in children. Int J Radiat Oncol Biol Phys 1990;
19:1497–502.
[15] Grill J, Le Deley MC, Gambarelli D, et al. Postoperative
chemotherapy without irradiation for ependymoma in children
under 5 years of age: a multicenter trial of the French Society
of Pediatric Oncology. J Clin Oncol 2001;19:1288–96.
[16] Grill J, Renaux VK, Bulteau C, et al. Long-term intellectual
outcome in children with posterior fossa tumors according to
radiation doses and volumes. Int J Radiat Oncol Biol Phys 1999;
45:137–45.
[17] Halberg FE, Kramer JH, Moore IM, Wara WM, Matthay KK,
Ablin AR. Prophylactic cranial irradiation dose effects on late
cognitive function in children treated for acute lymphoblastic
leukemia. Int J Radiat Oncol Biol Phys 1992;22:13–16.
[18] Healey EA, Barnes PD, Kupsky WJ, et al. The prognostic
significance of postoperative residual tumor in ependymoma.
Neurosurgery 1991;28:666–71 [discussion 671–662].
[19] Hoppe-Hirsch E, Brunet L, Laroussinie F, et al. Intellectual
outcome in children with malignant tumors of the posterior
fossa: influence of the field of irradiation and quality of
surgery. Childs Nerv Syst 1995;11:340–5 [discussion 345–346].
[20] Horowitz ME, Mulhern RK, Kun LE, et al. Brain tumors in the
very young child. Postoperative chemotherapy in combined-
modality treatment. Cancer 1988;61:428–34.
[21] Hukin J, Epstein F, Lefton D, Allen J. Treatment of intracranial
ependymoma by surgery alone. Pediatr Neurosurg 1998;29:
40–5.
[22] Jenkin D, Danjoux C, Greenberg M. Subsequent quality of life
for children irradiated for a brain tumor before age four years.
Med Pediatr Oncol 1998;31:506–11.
[23] Jereb B, Korenjak R, Krzisnik C, et al. Late sequelae in children
treated for brain tumors and leukemia. Acta Oncol 1994;33:
159–64.
[24] Kleihues P, Burger PC, Scheithauer BW. The new WHO
classification of brain tumours. Brain Pathol 1993;3:255–68.
[25] Kortmann RD, Kuhl J, Timmermann B, et al. Postoperative
neoadjuvant chemotherapy before radiotherapy as compared
to immediate radiotherapy followed by maintenance che-
motherapy in the treatment of medulloblastoma in childhood:
results of the German prospective randomized trial HIT ’91. Int
J Radiat Oncol Biol Phys 2000;46:269–79.
[26] Kortmann RD, Timmermann B, Kuhl J, et al. HIT ’91
(prospective, co-operative study for the treatment of malig-
nant brain tumors in childhood): accuracy and acute toxicity of
the irradiation of the craniospinal axis. Results of the quality
assurance program. Strahlenther Onkol 1999;175:162–9.
[27] Mainprize TG, Taylor MD, Rutka JT. Pediatric brain tumors: a
contemporary prospectus. Clin Neurosurg 2000;47:259–302.
[28] Massimino M, Gandola L, Cefalo G, et al. Management of
medulloblastoma and ependymoma in infants: a single-
institution long-term retrospective report. Childs Nerv Syst
2000;16:15–20.
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