Deferred radiation therapy

Retrospective reviews based on Surveillance, Epidemiology, and End Results Program data from children younger than 3 years at diagnosis were accrued over a 50-year period.[40]

Retrospective reviews based on Surveillance, Epidemiology, and End Results Program data from children younger than 3 years at diagnosis were accrued over a 50-year period.[40]

Results showed that patients who received local radiation therapy had better 10-year survival rates, even after adjusting for the extent of resection and tumor grade (WHO grade 2 vs. grade 3).

A large retrospective study, across 820 molecularly characterized posterior fossa ependymomas, demonstrated the following:[7]

A large retrospective study, across 820 molecularly characterized posterior fossa ependymomas, demonstrated the following:[7]

Adjuvant first-line radiation therapy, along with complete resection and PF-EPN-B subgroup, were associated with an improved prognosis.

A large retrospective study, across 820 molecularly characterized posterior fossa ependymomas, demonstrated the following:[7]

Radiation-sparing approaches were associated with dismal outcomes in children with PF-EPN-A tumors.

Conformal or charged-particle (e.g., proton) radiation therapy is an alternative approach for minimizing radiation-induced neurological damage in young children with ependymomas. The need and timing of radiation therapy for children who have successfully completed chemotherapy and have no residual disease is still to be determined.

Conformal or charged-particle (e.g., proton) radiation therapy is an alternative approach for minimizing radiation-induced neurological damage in young children with ependymomas. The need and timing of radiation therapy for children who have successfully completed chemotherapy and have no residual disease is still to be determined.

The initial experience with this approach suggested that children younger than 3 years with ependymomas have neurological deficits at diagnosis that improve with time after conformal radiation treatment.[17]

Conformal or charged-particle (e.g., proton) radiation therapy is an alternative approach for minimizing radiation-induced neurological damage in young children with ependymomas. The need and timing of radiation therapy for children who have successfully completed chemotherapy and have no residual disease is still to be determined.

Another study suggested that there was a trend for intellectual deterioration over time, even in older children treated with localized radiation therapy.[41]; [42][Level of evidence C1]

The COG ACNS0121 (NCT00027846) study showed that children aged 1 year to younger than 3 years who underwent a gross-total resection or near-total resection followed by immediate postoperative radiation therapy had the following results:[8][Level of evidence B4]

The COG ACNS0121 (NCT00027846) study showed that children aged 1 year to younger than 3 years who underwent a gross-total resection or near-total resection followed by immediate postoperative radiation therapy had the following results:[8][Level of evidence B4]

The 5-year EFS rate was 62.9%, and the OS rate was 87.4%.

The COG ACNS0121 (NCT00027846) study showed that children aged 1 year to younger than 3 years who underwent a gross-total resection or near-total resection followed by immediate postoperative radiation therapy had the following results:[8][Level of evidence B4]

These results were not statistically different from the results seen in patients aged 3 to 21 years, who had a 5-year EFS rate of 70.5% and an OS rate of 85.8%.

A multi-institutional trial of children younger than 3 years with newly diagnosed ependymomas (n = 54) who received four to six cycles of chemotherapy followed by radiation therapy (once they had reached the age of 12 months) resulted in the following:[29][Level of evidence B4]

A multi-institutional trial of children younger than 3 years with newly diagnosed ependymomas (n = 54) who received four to six cycles of chemotherapy followed by radiation therapy (once they had reached the age of 12 months) resulted in the following:[29][Level of evidence B4]

The 4-year PFS rate was 75.1%, and the OS rate was 92.6%.

A multi-institutional trial of children younger than 3 years with newly diagnosed ependymomas (n = 54) who received four to six cycles of chemotherapy followed by radiation therapy (once they had reached the age of 12 months) resulted in the following:[29][Level of evidence B4]

These results were comparable to the results seen in studies that treated children older than 3 years.

A multi-institutional trial of children younger than 3 years with newly diagnosed ependymomas (n = 54) who received four to six cycles of chemotherapy followed by radiation therapy (once they had reached the age of 12 months) resulted in the following:[29][Level of evidence B4]

Of interest, there was no difference in outcomes between infants younger than 1 year and children aged 1 to 3 years at diagnosis.