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Proton therapy effective for pediatric CNS ependymoma
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Children and adolescents with localized, intracranial ependymoma who underwent proton radiation therapy demonstrated favorable cognitive and survival outcomes, according to study results presented at the ASTRO Annual Meeting.
The analysis included 70 patients (mean age, 38 months; range, 3 months to 20 years) treated with involved field proton radiation between 2000 and 2011 at Massachusetts General Hospital.
Of them, 19 (27%) had supratentorial ependymoma and 51 (73%) had infratentorial ependymoma. At baseline, 37 patients (53%) had WHO grade 3 anaplastic histology, and the remainder of patients were classified with WHO grade 2 classic ependymoma.
Forty-six patients (66%) underwent gross total resection and 24 (34%) underwent subtotal resection.
Median follow-up was 46 months. Researchers reported a 3-year local control rate of 83%, a 3-year PFS rate of 76% and a 3-year OS rate of 95%.
Patients who underwent gross total resection experienced a significantly higher rate of 3-year PFS compared with those who underwent subtotal resection (88% vs. 54%; P=.001). Patients who underwent gross total resection also demonstrated a higher rate of 3-year OS (97% vs. 90%; P=.001).
Patients with classic ependymoma demonstrated a higher rate of 3-year PFS (83% vs. 69%; P=.509) than those with anaplastic histology, but the difference did not reach statistical significance.
In a subanalysis of 14 patients, whose parents completed Scales of Independent Behavior questionnaires, mean IQ increased from 108.5 at baseline t 111.3 after 2 years of follow-up. An assessment in a larger subset of patients (n=28) showed average scores increased from 100.1 at baseline to 100.8 after 2 years of follow-up.
Researchers reported low incidence of growth hormone deficiency, hypothyroidism and hearing loss.
“This study represents the best available evidence on the use of proton radiotherapy in the pediatric population,” researcher Shannon MacDonald, MD, a pediatric radiation oncologist at Massachusetts General Hospital, said in a press release. “Given the increasing numbers of proton facilities and the high cost of proton treatment, this data was urgently needed to provide evidence-based guidance on proton therapy outcomes for pediatric grain tumor patients.”
For more information:
Sethi R. Abstract #2188. Presented at: 2013 ASTRO Annual Meeting; Sept. 22-25, 2013; Atlanta.
Disclosure: One of the researchers reports stock ownership in ProCure.