Is craniospinal irradiation required to cure children with malignant (anaplastic) intracranial ependymomas?

Article Abstract:

Brain tumors pose special problems for clinicians. Since the brain is enclosed in a bony case, even small tumors can create harmful pressure on normal tissue within the enclosed space. Furthermore, it is impossible to operate on some regions within the brain. Radiation is often the treatment of choice, but radiation can be harmful; the potential harm is particularly great for children. Therefore, when radiotherapy for a childhood brain tumor cannot be avoided, every effort is made to focus the radiation as closely as possible only on the affected area. The ependyma is the thin layer of cells lining the ventricular spaces within the brain. When a benign tumor arises from the ependyma, radiation may be focused closely on the tumor with a reasonable chance of therapeutic success. However, some ependymal tumors (called ependymomas) are anaplastic, or highly malignant. It is uncertain whether carefully focused radiation offers an advantage in these cases. While carefully directed radiation helps to avoid radiation damage to normal tissue, if malignant cells have already spread away from their original ependymal site, then attempts to protect the rest of the head from radiation exposure will result in treatment failure. In a review of 17 cases of malignant ependymoma in children, five patients were treated only with carefully placed local irradiation. One patient received no radiation at all and the remaining 11 patients were given prophylactic radiation to the rest of the head and the upper portion of the spinal cord. At two years, 40 percent of the patients treated with local irradiation had survived, as had 52 percent of the patients treated with broader irradiation. But after a median follow-up period of six years, none of the patients who received only local irradiation remained alive, in contrast with five of the 11 patients who received broad prophylactic radiotherapy. However, the small number of patients in the present study, as well as the considerable variation among the patients themselves, precludes drawing any final conclusions about the importance of radiation to the head and spinal cord in young patients with malignant ependymoma. (Consumer Summary produced by Reliance Medical Information, Inc.)

Nervous system cancer

---

Recurrent intracranial ependymomas in children: survival, patterns of failure, and prognostic factors

Article Abstract:

An intracranial ependymoma is a tumor in the skull that results from the inclusion of ependyma during fetal development. Ependyma is the membrane that lines the chambers within the brain (cerebral ventricles) and the canal-like space within the spinal cord. The survival, prognosis, and treatment of 36 patients with recurrent intracranial ependymoma were assessed. The patients, ranging from less than one year to about 17 years old, experienced a total of 52 relapses between 1970 and 1989. Recurrent intracranial ependymoma was treated with surgery in 33 cases and with chemotherapy in 38 cases. Twelve patients were received radiation therapy for their first relapse. Five of these patients who were initially treated with surgery and chemotherapy received the full dose of radiation. Twenty-nine percent of the patients survived more than two years, and 23 percent remained free of disease progression. Thirty-nine percent of patients survived two years after treatment of their first relapse. Among 52 cases of recurrent intracranial ependymoma, there was one death and 44 relapses, including three of five patients treated with radiation. Relapse occurred at the site of the initial tumor in 27 cases, and at other body sites in eight cases. The incidence of survival was greater in patients with benign tumors and first relapses than in patients with malignant tumors and second or subsequent relapses. The anticancer agents cisplatin and etoposide were most effective against recurrent intracranial ependymomas. These findings suggest that aggressive treatment with anticancer agents may benefit patients with benign ependymomas at first relapse and may produce long-term survival, without disease progression in some cases. However, standard treatment may not be as effective in patients with malignant lesions and second or subsequent relapses. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prognosis, Tumors in children, Pediatric tumors

---

Results of treatment of children with recurrent medulloblastoma/primitive neuroectodermal tumors with lomustine, cisplatin, and vincristine

Article Abstract:

Children with medulloblastoma, a primitive tumor of the brain cerebellum, or primitive neuroectodermal tumors, may be treated with a combination of surgery and radiation. After these therapies, 50 to 60 percent will not have a recurrence. Those who do, however, face a bleak prognosis. It is very rare to achieve tumor control with chemotherapy given at relapse of primitive neuroectodermal tumor/medulloblastoma (PNET/MB). Previous research found a disease-free average survival of 18.8 months following treatment with a combination of lomustine, vincristine, prednisone, and methotrexate. This treatment protocol had serious side effects, including bone marrow suppression, inflammation of mucous membranes, and peripheral nerve damage. To examine the possibility of reducing these side effects and perhaps improving survival, seven children aged 2 to 18 with recurrent PNET/MB were treated with a combination of lomustine, cisplatin, and vincristine. Treatment consisted of a maximum of eight 6-week cycles. One patient experienced disease progression during the first cycle and was removed from the study. Of the remaining six patients, four responded completely. The median disease-free survival was 18.5 months, and all have since died of recurrent tumors. During treatment, all six children experienced bone marrow suppression and high-frequency hearing loss; three also had decreased kidney function. Although the side effects were significant, no life-threatening complications occurred. This treatment regimen prolonged survival with a reasonable quality of life. Whether this treatment protocol is superior to other chemotherapeutic regimens will require further study. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cancer in children, Childhood cancer, Chemotherapy, Medulloblastoma, Brain cancer

Similar abstracts:

• Abstracts: Is chemotherapy effective in reducing the local failure rate in patients with operable breast cancer? Angiosarcoma arising in an irradiated breast: a case report and review of the literature
• Abstracts: Is chemotherapy effective in reducing the local failure rate in patients with operable breast cancer? part 2 Role of adjuvant chemotherapy in male breast cancer
• Abstracts: Testicular seminoma: results of the Yale University experience, 1964-1984. Staging, treatment, and results in testicular seminoma: a 12-year report

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.