Researchers affiliated with the UK Childrens Cancer and Leukaemia Group Brain Tumor Committee have reported that post-operative chemotherapy can delay or eliminate the need for radiation therapy in many young children with ependymoma without compromising survival. The details of this study appeared in the August 2001 issue of Lancet Oncology.
Treatment of ependymoma often includes surgery to remove as much of the tumor as possible, and may also include radiation therapy or chemotherapy. Although radiation therapy is effective, a concern with the use of radiation therapy to the brain is that it can cause cognitive impairment and other problems, particularly when given to very young children (children under the age of three years).
This study evaluated the efficacy of post-surgery treatment with chemotherapy in 89 children age three or younger. After surgery all study participants were treated with alternating cycles of myeloablative and non-myeloablative chemotherapy. The intended duration of the chemotherapy was one year. Radiation therapy was not given until there was evidence of cancer progression.
- Among children with non-metastatic cancer at the time of initial diagnosis, 42% avoided radiation therapy for at least five years.
- Overall three-year survival was 79%, and overall five-year survival was 63%.
- For the children who received radiation therapy as a result of cancer progression, the median delay in radiation therapy was 20 months.
The researchers concluded that post-surgery treatment with chemotherapy “avoided or delayed radiotherapy in a substantial proportion of children younger than 3 years without compromising survival.”
Comments: An accompanying editorial took issue with some of the conclusions of this study.[2] They pointed out that no response data were given and no neurocognitive studies were performed. They also cited a study from St Jude Research Hospital which achieved comparable results with conformal radiotherapy with preservation of neurocognitive function. They suggested that conformal radiotherapy was still the standard of care.
References:
[1] Grundy RG, Wilne SA, Weston CI et al. Primary postoperative chemotherapy without radiotherapy for intracranial ependymoma: the UKCCSG/SIOP prospective study. Lancet Oncology. 2007; 8:696-705.
[2] Bouffet E, TAbori U, Bartels U. Pediatric ependymonas: should we avoid radiotherapy? Lancet Oncology. 2007; 8:666=667.
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