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Liu KX, Indelicato DJ, Paulino AC, Looi WS, Catalano PJ, Chintagumpala MM, Gallotto SL, Marcus KJ, Haas-Kogan DA, Tarbell NJ, MacDonald SM, Mahajan A, Yock TI. Multi-institutional Characterization of Outcomes for Pediatric and Young Adult Patients With High-Risk Myxopapillary Ependymoma After Radiation Therapy. Int J Radiat Oncol Biol Phys 2023; 117:1174-1180. [PMID: 37437812 DOI: 10.1016/j.ijrobp.2023.06.2293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 06/12/2023] [Accepted: 06/26/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE Myxopapillary ependymoma (MPE) is a rare, typically slow-growing subtype of spinal ependymomas. There are no standard guidelines for radiotherapy and long-term outcomes after radiation, particularly patterns of relapse, for pediatric and young adult (YA) patients with MPE remain under-characterized. METHODS AND MATERIALS This is an Institutional Review Board-approved multi-institutional retrospective cohort study of 60 pediatric and YA patients diagnosed with MPE and received radiotherapy between 2000-2020. Clinical and treatment characteristics, and long-term outcomes were recorded. Site(s) of progression was compared to radiation fields. Survival outcomes were analyzed using Kaplan-Meier method. Cumulative incidence of local in-field progression (CILP) after initial radiotherapy was analyzed using Gray's method with out-of-field-only progression as a competing risk. Univariate analyses were performed using Cox proportional hazard's model. RESULTS The median age at radiation was 14.8 years (range: 7.1-26.5). At time of radiotherapy, 45 (75.0%) and 35 (58.3%) patients had gross residual and multifocal disease, respectively. Forty-eight (80.0%), seven (11.7%) and five (8.3%) patients received involved field radiotherapy, craniospinal irradiation, and whole spine radiation, respectively. Median follow-up from end of radiotherapy was 6.2 years (range: 0.6-21.0). Five-year overall survival, progression-free survival, and CILP were 100%, 60.8% and 4.1%, respectively. Both local recurrences were at sites of gross residual disease. Of the eighteen out-of-field first recurrences after radiotherapy, all were superior to the initial treatment field and nine had intracranial relapse. On univariate analyses, distant-only recurrence before radiation (HR: 4.00, 95% CI: 1.54-10.43, p = 0.005) was significantly associated with shorter time to progression. CONCLUSIONS While the risk of recurrence within the radiation field is low, pediatric and YA patients with high-risk MPE remain at risk for recurrences in the spine above the radiation field and intracranially after radiotherapy. Future prospective studies are needed to investigate the appropriate radiation field and dose based on the extent of metastases.
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Affiliation(s)
- Kevin X Liu
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel J Indelicato
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Arnold C Paulino
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Wen S Looi
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Paul J Catalano
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Murali M Chintagumpala
- Department of Pediatrics, Division of Hematology-Oncology, Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Sara L Gallotto
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Karen J Marcus
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daphne A Haas-Kogan
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nancy J Tarbell
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Inspire Exercise Medicine, Naples, Florida
| | - Shannon M MacDonald
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Torunn I Yock
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
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Johnson RA, Cramer SW, Dusenbery K, Samadani U. Resection of disseminated recurrent myxopapillary ependymoma with more than 4-year follow-up: operative nuance for prolonged prone position. Illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE2235. [PMID: 36303501 PMCID: PMC9379707 DOI: 10.3171/case2235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 02/15/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Symptomatic disseminated myxopapillary ependymoma (MPE) in a young person presents a daunting challenge because the risks of prolonged prone positioning and spinal cord injury may outweigh the likelihood of attaining the benefit of gross total resection. OBSERVATIONS The authors reported the case of a 15-year-old girl with five discrete recurrent spinal cord ependymomas. The patient received a 25-hour surgical procedure for gross total resection of the tumors and fusion over an approximately 33-hour period. She experienced complete resolution of all preoperative neurological symptoms and subsequently received adjuvant radiation therapy. At 52 months after surgery, she was still experiencing neurologically intact, progression-free survival. This case illustrated one of the most extensive recurrent tumor resections for MPE with prolonged disease-free survival reported to date. It may also represent the longest prone position spinal case reported and was notable for a lack of any of the complications commonly associated with the prolonged prone position. LESSONS The authors discussed the complexity of surgical decision-making in a symptomatic patient with multiple disseminated metastases, technical considerations for resection of intradural and intramedullary spinal cord tumors, and considerations for avoiding complications during prolonged positioning necessary for spinal surgery.
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Affiliation(s)
- Reid A. Johnson
- University of Minnesota Medical School, Minneapolis, Minnesota
| | | | | | - Uzma Samadani
- Surgical Services, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, Minnesota; and
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Welmant J, Helfre S, Carton M, Bolle S, Minard-Colin V, Corradini N, Pannier S, Rome A, Mansuy L, Vérité C, Castex MP, Kerr C, Defachelles AS, Bernier V, Orbach D. Pattern of relapse in pediatric localized extremity rhabdomyosarcomas correlated with locoregional therapies administered. Strahlenther Onkol 2021; 197:690-699. [PMID: 33914102 DOI: 10.1007/s00066-021-01780-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/26/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Treatment of extremity rhabdomyosarcomas (RMS) includes chemotherapy, surgery, and radiotherapy. Lymph node irradiation is recommended in the presence of regional node involvement at diagnosis. The aim of this study was to analyze the correlation between the pattern of relapse of non-metastatic extremity RMS and the initial therapies delivered. METHODS All patients with localized extremity RMS prospectively treated in France in the MMT-95 and RMS-05 protocols were selected. Extent of disease and pattern of relapse were evaluated by clinical examination and imaging. RESULTS We identified 59 patients with clinical characteristics corresponding to unfavorable prognostic factors. Twenty patients (34%) were considered to have lymph node involvement at diagnosis. Regional node biopsy was performed in 32 patients (54%) and modified the lymph node stage in 8 of the 59 patients (14%). Seventy-three percent of patients received radiotherapy. Fifty-two patients achieved first remission. Overall, 26 patients underwent complete tumor resection, 17 had R1 margins, and 5 were not operated due to early tumor progression. With a median follow-up of 82 months (range: 5-287), 18 relapses had occurred, at least locoregional in 12 cases. The 5‑year local and nodal control rates were 73% (63-86%) and 86% (77-95%), respectively. Five-year progression-free and overall survival were 57% (95%CI [45-72%]) and 70% (95%CI [58-84%]), respectively. CONCLUSION The main sites of extremity RMS relapse are locoregional. Nodal failures in non-irradiated fields are not uncommon. We recommend systematic biopsy of in-transit nodes, especially in alveolar RMS and/or RMS with regional positive nodes at diagnosis to ensure their negativity.
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Affiliation(s)
- Julien Welmant
- Department of Radiation Oncology and Physics, Institut du Cancer de Montpellier, Montpellier, France
| | - Sylvie Helfre
- Radiotherapy Department, Institut Curie, Paris, France
| | - Matthieu Carton
- PSL Research University, DRCI, Biométrie, Institut Curie, Saint-Cloud, France
| | - Stéphanie Bolle
- Department of Radiotherapy Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Véronique Minard-Colin
- Department of Oncology for Children and Adolescents, Gustave Roussy Cancer Campus, Villejuif, France
| | - Nadège Corradini
- Department of Paediatric Haematology and Oncology, Centre Léon Bérard, Lyon, France
| | - Stéphanie Pannier
- Department of Orthopaedic Paediatrics, Necker-Enfants-Malades Hospital, Paris, France
| | - Angélique Rome
- Department of Paediatric Oncology, CHU de Marseille, Hôpital de la Timone, Marseille, France
| | - Ludovic Mansuy
- Oncology Surgery Department, Institute of Cancerology of Lorraine, Nancy, France
| | - Cécile Vérité
- Paediatric Hematology Unit, Groupe Hospitalier Pellegrin, Bordeaux, France
| | | | - Christine Kerr
- Department of Radiation Oncology and Physics, Institut du Cancer de Montpellier, Montpellier, France
| | | | - Valérie Bernier
- Department of Radiotherapy Oncology, Institute of Cancerology of Lorraine, Nancy, France
| | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation, and research for children and AYA with cancer), PSL Research University, Institut Curie, Paris, France. .,French Pediatric Rare Tumor group (Fracture group), Institut Curie, 26, rue d'Ulm, 75005, Paris, France.
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