Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennesse.
Int J Radiat Oncol Biol Phys. 2023 Jul 15;116(4):869-877. doi: 10.1016/j.ijrobp.2023.01.016. Epub 2023 Jan 20.
Adjuvant radiation therapy (RT) affects survival after surgery for young children (age <3 years) diagnosed with intracranial ependymoma. Conformal photon RT promised to spare normal tissue and was introduced more than 25 years ago to improve outcomes for these vulnerable patients. Long-term results for those first treated with conformal methods provide valuable information and serve as a comparison against newer methods.
Between 1997 and 2018, 101 patients <3.1-years-old were treated with conformal and intensity modulated photon therapy after definitive surgery for intracranial ependymoma. The median age at RT was 2.1 years and the time from diagnosis to the start of RT was 10 weeks. The extent of resection was gross-total in 82%, and 38% underwent more than 1 attempt at resection. The total prescribed dose was 54 to 59.4 Gy at 1.8 Gy per fraction.
The 10-year event-free and overall survivals were 58.5% ± 5.0% and 72.6% ± 4.5%, respectively, with a median follow-up of 18.4 years (range, 4.2-23.3 years). Tumor progression occurred in 34 patients with a median time of 1.6 years. Death occurred in 34 patients from ependymoma (n = 24), secondary malignancy (n = 6), necrosis (n = 2), shunt failure (n = 1), and anaphylactic reaction (n = 1). Twenty-three patients developed a secondary tumor including 6 cases of fatal high-grade glioma. Of the surviving cohort and those ≥18 years old, 98% obtained a high school diploma, 64% had a current driver's license, 89% were students or employed full or part time, 32% were living independently, and 70% received higher education or training.
Long-term results of children treated using photon conformal RT after surgery demonstrate that adjuvant RT resulted in long-term disease control and functional independence. These results point to the need for new treatment strategies to improve tumor control and provide investigators hope that newer RT methods will further reduce complications.
辅助放疗（RT）会影响 3 岁以下颅内室管膜瘤患儿手术后的生存情况。适形光子 RT 承诺能保护正常组织，它在 25 年前被引入，旨在改善这些脆弱患者的治疗效果。首批接受适形方法治疗的患者的长期结果提供了有价值的信息，并与新方法进行了比较。
1997 年至 2018 年间，101 名年龄小于 3.1 岁的患儿在接受明确的颅内室管膜瘤手术后，接受了适形调强光子放疗。放疗时的中位年龄为 2.1 岁，从诊断到开始放疗的时间为 10 周。82%的患者实现了大体全切除，38%的患者进行了超过 1 次的切除术尝试。总处方剂量为 54 至 59.4Gy，分割剂量为 1.8Gy。
10 年无事件生存率和总生存率分别为 58.5%±5.0%和 72.6%±4.5%，中位随访时间为 18.4 年（范围为 4.2-23.3 年）。34 名患者发生肿瘤进展，中位时间为 1.6 年。34 名患者因室管膜瘤（n=24）、继发性恶性肿瘤（n=6）、坏死（n=2）、分流失败（n=1）和过敏反应（n=1）而死亡。23 名患者发生了继发性肿瘤，包括 6 例致命性高级别胶质瘤。在存活队列和 18 岁以上的患者中，98%的人获得了高中文凭，64%的人有当前的驾照，89%的人是学生或全职或兼职工作，32%的人独立生活，70%的人接受了高等教育或培训。
术后接受光子适形 RT 治疗的儿童的长期结果表明，辅助 RT 可实现长期疾病控制和功能独立。这些结果表明需要新的治疗策略来提高肿瘤控制率，并为研究人员带来希望，即新的 RT 方法将进一步减少并发症。
