Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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Treatment outcome of anaplastic ependymoma under the age of 3 treated by intensity-modulated radiotherapy

  • Lee, Joongyo (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Chung, Seung Yeun (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Han, Jung Woo (Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine) ;
  • Kim, Dong-Seok (Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine) ;
  • Kim, Jina (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Moon, Jin Young (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Yoon, Hong In (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Suh, Chang-Ok (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine)
  • Received : 2020.02.06
  • Accepted : 2020.03.16
  • Published : 2020.03.31
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Abstract

Purpose: Intensity-modulated radiotherapy (IMRT) allows for more precise treatment, reducing unwanted radiation to nearby structures. We investigated the safety and feasibility of IMRT for anaplastic ependymoma patients below 3 years of age. Materials and Methods: A total of 9 anaplastic ependymoma patients below 3 years of age, who received IMRT between October 2011 and December 2017 were retrospectively reviewed. The median equivalent dose in 2 Gy fractions was 52.0 Gy (range, 48.0 to 60.0 Gy). Treatment outcomes and neurologic morbidities were reviewed in detail. Results: The median patient age was 20.9 months (range, 12.1 to 31.2 months). All patients underwent surgery. The rates of 5-year overall survival, freedom from local recurrence, and progression-free survival were 40.6%, 53.3%, and 26.7%, respectively. Of the 9 patients, 5 experienced recurrences (3 had local recurrence, 1 had both local recurrence and cerebrospinal fluid [CSF] seeding, and 1 had CSF seeding alone). Five patients died because of disease progression. Assessment of neurologic morbidity revealed motor dysfunction in 3 patients, all of whom presented with hydrocephalus at initial diagnosis because of the location of the tumor and already had neurologic deficits before radiotherapy (RT). Conclusion: Neurologic morbidity is not caused by RT alone but may result from mass effects of the tumor and surgical sequelae. Administration of IMRT to anaplastic ependymoma patients below 3 years of age yielded encouraging local control and tolerable morbidities. High-precision modern RT such as IMRT can be considered for very young patients with anaplastic ependymoma.

Keywords

References

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