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Int J Radiat Oncol Biol Phys. 2008 Jul 15;71(4):987-93. doi: 10.1016/j.ijrobp.2007.11.058. Epub 2008 Feb 6.

Intensity-modulated radiation therapy in childhood ependymoma.

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1
Department of Radiation Oncology, University of New Mexico Cancer Center, The University of New Mexico, Albuquerque, NM, USA.

Abstract

PURPOSE:

To determine the patterns of failure after intensity-modulated radiation therapy (IMRT) for localized intracranial ependymoma.

METHODS AND MATERIALS:

From 1994 to 2005, 22 children with pathologically proven, localized, intracranial ependymoma were treated with adjuvant IMRT. Of the patients, 12 (55%) had an infratentorial tumor and 14 (64%) had anaplastic histology. Five patients had a subtotal resection (STR), as evidenced by postoperative magnetic resonance imaging. The clinical target volume encompassed the tumor bed and any residual disease plus margin (median dose 54 Gy). Median follow-up for surviving patients was 39.8 months.

RESULTS:

The 3-year overall survival rate was 87% +/- 9%. The 3-year local control rate was 68% +/- 12%. There were six local recurrences, all in the high-dose region of the treatment field. Median time to recurrence was 21.7 months. Of the 5 STR patients, 4 experienced recurrence and 3 died. Patients with a gross total resection had significantly better local control (p = 0.024) and overall survival (p = 0.008) than those with an STR. At last follow-up, no patient had developed visual loss, brain necrosis, myelitis, or a second malignancy.

CONCLUSIONS:

Treatment with IMRT provides local control and survival rates comparable with those in historic publications using larger treatment volumes. All failures were within the high-dose region, suggesting that IMRT does not diminish local control. The degree of surgical resection was shown to be significant for local control and survival.

PMID:
18258381
DOI:
10.1016/j.ijrobp.2007.11.058
[Indexed for MEDLINE]
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