Details

Autor(en) / Beteiligte

• Gupta, Tejpal
• Maitre, Madan
• Gupta, Priyamvada
• Krishnatry, Rahul
• Chatterjee, Abhishek
• Moiyadi, Aliasgar
• Shetty, Prakash
• Singh, Vikas
• Chinnaswamy, Girish
• Epari, Sridhar
• Sahay, Ayushi
• Patil, Vijay
• GodaSastri, Jayant

Titel

Extent of re-excision, sequence/timing of salvage re-irradiation, and disease-free interval impact upon clinical outcomes in recurrent/progressive ependymoma

Ist Teil von

• Journal of neuro-oncology, 2020-04, Vol.147 (2), p.405-415

Ort / Verlag

New York: Springer US

Erscheinungsjahr

2020

Quelle

MEDLINE

Beschreibungen/Notizen

• Purpose To report clinical outcomes of salvage re-irradiation (re-RT) in recurrent/progressive ependymoma. Methods Medical records of patients treated with curative-intent re-RT as multi-modality management for recurrent/progressive ependymoma were analyzed retrospectively. The linear-quadratic model was used to provide estimates of biologically effective dose (BED) of irradiation using an α/β value of 2 for late CNS toxicity for each course of irradiation and summated to derive cumulative BED without correcting for the assumed recovery. Results A total of 55 patients (median age 10 years at index diagnosis) treated with curative-intent re-RT between 2010 and 2018 were included. Median time to first recurrence was 29 months with an inter-quartile range (IQR) of 16–64 months. Majority (n = 46, 84%) of patients underwent surgical re-excision of recurrent disease. Median interval from first course of irradiation (RT1) to second course (RT2) was 35 months (IQR = 26–66 months) with a median re-RT dose of 54 Gy in 30 fractions (range 40–60 Gy), resulting in median cumulative equivalent dose in 2 Gy fraction (EQD2) of 106.2 Gy (range 92.4–117.6 Gy). Volume of re-RT was based on location and pattern of relapse, comprising uni-focal (n = 49, 89%), multi-focal (n = 3, 5.5%), or craniospinal irradiation (CSI) in 3 (5.5%) patients respectively. Thirty-six (66%) patients received platinum-based salvage chemotherapy either before or after RT2. At a median follow up of 37 months (range 6–80 months), the Kaplan–Meier estimates of 3-year progression-free survival (PFS) and overall survival (OS) for the entire study cohort were 40% and 51% respectively. Gross total resection at recurrence; early salvage re-RT (prior to chemotherapy, if any); and longer (> 2 years) disease-free interval (DFI) were associated with better survival outcomes. Salvage re-RT was generally well tolerated with only 3 (5.5%) patients developing symptomatic radiation necrosis necessitating corticosteroids. Conclusion Extent of re-excision, sequence/timing of re-RT, and DFI impact upon outcomes in curative-intent, multi-modality salvage therapy for recurrent ependymoma.