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Clinical Trial
. 2016 Oct;18(10):1451-60.
doi: 10.1093/neuonc/now108. Epub 2016 May 18.

Final results of the second prospective AIEOP protocol for pediatric intracranial ependymoma

Maura Massimino  1 , Rosalba Miceli  1 , Felice Giangaspero  1 , Luna Boschetti  1 , Piergiorgio Modena  1 , Manila Antonelli  1 , Paolo Ferroli  1 , Daniele Bertin  1 , Emilia Pecori  1 , Laura Valentini  1 , Veronica Biassoni  1 , Maria Luisa Garrè  1 , Elisabetta Schiavello  1 , Iacopo Sardi  1 , Armando Cama  1 , Elisabetta Viscardi  1 , Giovanni Scarzello  1 , Silvia Scoccianti  1 , Maurizio Mascarin  1 , Lucia Quaglietta  1 , Giuseppe Cinalli  1 , Barbara Diletto  1 , Lorenzo Genitori  1 , Paola Peretta  1 , Anna Mussano  1 , Annamaria Buccoliero  1 , Giuseppina Calareso  1 , Salvina Barra  1 , Angela Mastronuzzi  1 , Carlo Giussani  1 , Carlo Efisio Marras  1 , Rita Balter  1 , Patrizia Bertolini  1 , Ermanno Giombelli  1 , Milena La Spina  1 , Francesca R Buttarelli  1 , Bianca Pollo  1 , Lorenza Gandola  1
Affiliations
Clinical Trial

Final results of the second prospective AIEOP protocol for pediatric intracranial ependymoma

Maura Massimino et al. Neuro Oncol. 2016 Oct.

Abstract

Background: This prospective study stratified patients by surgical resection (complete = NED vs incomplete = ED) and centrally reviewed histology (World Health Organization [WHO] grade II vs III).

Methods: WHO grade II/NED patients received focal radiotherapy (RT) up to 59.4 Gy with 1.8 Gy/day. Grade III/NED received 4 courses of VEC (vincristine, etoposide, cyclophosphamide) after RT. ED patients received 1-4 VEC courses, second-look surgery, and 59.4 Gy followed by an 8-Gy boost in 2 fractions on still measurable residue. NED children aged 1-3 years with grade II tumors could receive 6 VEC courses alone.

Results: From January 2002 to December 2014, one hundred sixty consecutive children entered the protocol (median age, 4.9 y; males, 100). Follow-up was a median of 67 months. An infratentorial origin was identified in 110 cases. After surgery, 110 patients were NED, and 84 had grade III disease. Multiple resections were performed in 46/160 children (28.8%). A boost was given to 24/40 ED patients achieving progression-free survival (PFS) and overall survival (OS) rates of 58.1% and 68.7%, respectively, in this poor prognosis subgroup. For the whole series, 5-year PFS and OS rates were 65.4% and 81.1%, with no toxic deaths. On multivariable analysis, NED status and grade II were favorable for OS, and for PFS grade II remained favorable.

Conclusions: In a multicenter collaboration, this trial accrued the highest number of patients published so far, and results are comparable to the best single-institution series. The RT boost, when feasible, seemed effective in improving prognosis. Even after multiple procedures, complete resection confirmed its prognostic strength, along with tumor grade. Biological parameters emerging in this series will be the object of future correlatives and reports.

Keywords: boost; ependymoma; grade; prognosis; surgery.

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Figures

Fig. 1.
Fig. 1.
(A) Treatment diagram and (B) patient flow during treatment.
Fig. 2.
Fig. 2.
Kaplan–Meier PFS and OS curves for the whole series.
Fig. 3.
Fig. 3.
(A) Kaplan-Meier PFS and (B) OS curves by outcome of first surgery.
See this image and copyright information in PMC

References

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