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Treatment outcome of anaplastic ependymoma under the age of 3 treated by intensity-modulated radiotherapy

Radiation Oncology Journal 2020년 38권 1호 p.26 ~ 34
Lee Joon-Gyo, Chung Seung-Yeun, 한정우, 김동석, 김지나, 문진영, Yoon Hong-In, 서창옥,
소속 상세정보
 ( Lee Joon-Gyo ) - Yonsei University College of Medicine Yonsei Cancer Center Department of Radiation Oncology
 ( Chung Seung-Yeun ) - Yonsei University College of Medicine Yonsei Cancer Center Department of Radiation Oncology
한정우 ( Han Jung-Woo ) - Yonsei University College of Medicine Severance Hospital Department of Pediatrics
김동석 ( Kim Dong-Seok ) - Yonsei University College of Medicine Severance Hospital Department of Neurosurgery
김지나 ( Kim Jina ) - Yonsei University College of Medicine Yonsei Cancer Center Department of Radiation Oncology
문진영 ( Moon Jin-Young ) - Yonsei University College of Medicine Yonsei Cancer Center Department of Radiation Oncology
 ( Yoon Hong-In ) - Yonsei University College of Medicine Yonsei Cancer Center Department of Radiation Oncology
서창옥 ( Suh Chang-Ok ) - Yonsei University College of Medicine Yonsei Cancer Center Department of Radiation Oncology

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.

키워드

Pediatrics; Ependymoma; Intensity-modulated radiotherapy; Local neoplasm recurrence; Morbidity

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