Postoperative Chemotherapy Without Irradiation for Ependymoma in Children Under 5 Years of Age: A Multicenter Trial of the French Society of Pediatric Oncology

Author:

Grill Jacques1,Le Deley Marie-Cécile1,Gambarelli Danièle1,Raquin Marie-Anne1,Couanet Dominique1,Pierre-Kahn Alain1,Habrand Jean-Louis1,Doz François1,Frappaz Didier1,Gentet Jean-Claude1,Edan Christine1,Chastagner Pascal1,Kalifa Chantal1

Affiliation:

1. From the Departments of Pediatrics, Biostatistics, Radiology, and Radiotherapy, Institut Gustave Roussy, Villejuif; Department of Neuropathology, University Hospital; Department of Pediatric Hematology/Oncology, La Timone Hospital, Marseille; Department of Pediatric Neurosurgery, Necker Hospital; Department of Pediatrics, Institut Curie, Paris; Department of Pediatrics, Centre Léon Bérard, Lyon; Department of Pediatric Hematology/Oncology, University Hospital, Rennes; and Department of Pediatric...

Abstract

PURPOSE: To evaluate a strategy that avoids radiotherapy in first-line treatment in children under 5 years of age with brain or posterior fossa ependymoma, by exclusively administering 16 months of adjuvant multiagent chemotherapy after surgery. PATIENTS AND METHODS: Between June 1990 and October 1998, 73 children with ependymoma (82% with high-grade tumors) were enrolled onto this multicenter trial. Children received adjuvant conventional chemotherapy after surgery consisting of seven cycles of three courses alternating two drugs at each course (procarbazine and carboplatin, etoposide and cisplatin, vincristine and cyclophosphamide) over a year and a half. Systematic irradiation was not envisaged at the end of chemotherapy. In the event of relapse or progression, salvage treatment consisted of a second surgical procedure followed by local irradiation with or without second-line chemotherapy. RESULTS: Conventional chemotherapy was well tolerated and could be administered in outpatient clinics. No radiologically documented response to chemotherapy more than 50% was observed. With a median follow-up of 4.7 years (range, 5 months to 8 years), the 4-year progression-free survival rate in this series was 22% (95% confidence interval [CI], 13% to 43%) and the overall survival rate was 59% (95% CI, 47% to 71%). Overall, 40% (95% CI, 29% to 51%) of the patients were alive having never received radiotherapy 2 years after the initiation of chemotherapy and 23% (95% CI, 14% to 35%) were still alive at 4 years without recourse to this modality. In the multivariate analysis, the two factors associated with a favorable outcome were a supratentorial tumor location (P = .0004) and complete surgery (P = .0009). Overall survival at 4 years was 74% (95% CI, 59% to 86%) for the patients in whom resection was radiologically complete and 35% (95% CI, 18% to 56%) for the patients with incomplete resection. CONCLUSION: A significant proportion of children with ependymoma can avoid radiotherapy with prolonged adjuvant chemotherapy. Deferring irradiation at the time of relapse did not compromise overall survival of the entire patient population.

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

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