Aggressive surgery, targeted radiotherapy can treat rare childhood brain cancer

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Aggressive surgery followed by targeted radiotherapy is the optimal means by which a rare form of childhood brain cancer should be treated, according to a study published online Jan. 30, and is scheduled to appear in the March issue of the Lancet Oncology.

Although aggressive surgical intervention has proved successful in treating such tumors in older patients, concern over side-effects has limited the take-up of radiation therapy in children with the disease.
However, recent developments in neurosurgery and in the administration of radiation led Thomas Merchant, MD, of St Jude Children's Research Hospital in Memphis, Tenn., and colleagues to begin to treat children with localized ependymoma with aggressive surgery followed by computer-guided radiation therapy.

In the study, the researchers reported outcomes for 153 children treated in this manner, including, for the first time, children under the age of three. The children were then followed up for a median duration of 5.3 years, and 23 patients died. Tumor progression was reported in 36 patients.

The investigators estimated that event-free survival at seven years would be 69.1 percent, and overall survival 81 percent. Local tumor control was better than expected, with a seven-year estimate of 87.3 percent. They wrote that treatment was generally well tolerated.

Merchant and colleagues reported that patients who underwent radiation therapy without delay after surgery showed even better event-free survival (76.9 percent) and overall survival (85 percent). Although there was no control group in this trial, the authors said that the rates compare favorably with those achieved in other studies.

“This study highlights the long-term benefits…of gross total resection and high-dose post-operative radiotherapy for the treatment of children with localized ependymoma, even for those who are younger than three years,” Merchant said.

“Newer methods of radiotherapy delivery promise further reductions in the dose [delivered] to healthy tissue" to further reduce radiotherapy-related side-effects, and "provides unique insight into the role of radiation therapy in the initial management of young children, and that future efforts to combat ependymoma should also prioritize increasing the rate of gross total resection,” he added.