Purpose The aims of patients’ radiological surveillance are to: ascertain relapse; apply second-line therapy; accrue patients in phase 1/2 protocols if second-line therapy is not standardized/curative; and assess/treat iatrogenic effects. To lessen the emotional and socioeconomic burdens for patients and families, we ideally need to establish whether scheduled radiological surveillance gives patients a better outcome than waiting for symptoms and signs to appear. Methods We analyzed a prospective series of 160 newly-diagnosed and treated pediatric/adolescent patients with intracranial ependymoma, comparing patients with recurrent disease identified on scheduled MRI (the RECPT group; 34 cases) with those showing signs/symptoms of recurrent disease (the SYMPPT group; 16 cases). The median follow-up was 67 months. Results No significant differences emerged between the two groups in terms of gender, age, tumor grade/site, shunting, residual disease, or type of relapse (local, distant, or concomitant). The time to relapse (median 19 months; range 5–104) and the MRI follow-up intervals did not differ between the SYMPPT and RECPT groups. The presence of signs/symptoms was an unfavorable factor for overall survival (OS) after recurrence (5-year OS: 8% vs. 37%, p = 0.001). On multivariable analysis, an adjusted model confirmed a significantly worse OS in the SYMPPT than in the RECPT patients. Conclusions Symptomatic relapses carried a significantly worse survival for ependymoma patients than recurrences detected by MRI alone. It would therefore be desirable to identify recurrences before symptoms develop. Radiological follow-up should be retained in ependymoma patient surveillance because there is a chance of salvage treatment for relapses found on MRI.

Massimino, M., Barretta, F., Modena, P., Giangaspero, F., Chiapparini, L., Erbetta, A., Boschetti, L., Antonelli, M., Ferroli, P., Bertin, D., Pecori, E., Biassoni, V., Garrè, M. L., Schiavello, E., Sardi, I., Viscardi, E., Scarzello, G., Mascarin, M., Quaglietta, L., Cinalli, G., Genitori, L., Peretta, P., Mussano, A., Barra, S., Mastronuzzi, A., Giussani, C., Marras, C. E., Balter, R., Bertolini, P., Tornesello, A., La Spina, M., Buttarelli, F. R., Ruggiero, A., Caldarelli, M., Poggi, G., Gandola, L., Pediatric intracranial ependymoma: correlating signs and symptoms at recurrence with outcome in the second prospective AIEOP protocol follow-up, <<JOURNAL OF NEURO-ONCOLOGY>>, 2018; 140 (2): 457-465. [doi:10.1007/s11060-018-2974-6] [http://hdl.handle.net/10807/148222]

Pediatric intracranial ependymoma: correlating signs and symptoms at recurrence with outcome in the second prospective AIEOP protocol follow-up

Tornesello, Assunta;Ruggiero, Antonio;Caldarelli, Massimo;
2018

Abstract

Purpose The aims of patients’ radiological surveillance are to: ascertain relapse; apply second-line therapy; accrue patients in phase 1/2 protocols if second-line therapy is not standardized/curative; and assess/treat iatrogenic effects. To lessen the emotional and socioeconomic burdens for patients and families, we ideally need to establish whether scheduled radiological surveillance gives patients a better outcome than waiting for symptoms and signs to appear. Methods We analyzed a prospective series of 160 newly-diagnosed and treated pediatric/adolescent patients with intracranial ependymoma, comparing patients with recurrent disease identified on scheduled MRI (the RECPT group; 34 cases) with those showing signs/symptoms of recurrent disease (the SYMPPT group; 16 cases). The median follow-up was 67 months. Results No significant differences emerged between the two groups in terms of gender, age, tumor grade/site, shunting, residual disease, or type of relapse (local, distant, or concomitant). The time to relapse (median 19 months; range 5–104) and the MRI follow-up intervals did not differ between the SYMPPT and RECPT groups. The presence of signs/symptoms was an unfavorable factor for overall survival (OS) after recurrence (5-year OS: 8% vs. 37%, p = 0.001). On multivariable analysis, an adjusted model confirmed a significantly worse OS in the SYMPPT than in the RECPT patients. Conclusions Symptomatic relapses carried a significantly worse survival for ependymoma patients than recurrences detected by MRI alone. It would therefore be desirable to identify recurrences before symptoms develop. Radiological follow-up should be retained in ependymoma patient surveillance because there is a chance of salvage treatment for relapses found on MRI.
Inglese
Massimino, M., Barretta, F., Modena, P., Giangaspero, F., Chiapparini, L., Erbetta, A., Boschetti, L., Antonelli, M., Ferroli, P., Bertin, D., Pecori, E., Biassoni, V., Garrè, M. L., Schiavello, E., Sardi, I., Viscardi, E., Scarzello, G., Mascarin, M., Quaglietta, L., Cinalli, G., Genitori, L., Peretta, P., Mussano, A., Barra, S., Mastronuzzi, A., Giussani, C., Marras, C. E., Balter, R., Bertolini, P., Tornesello, A., La Spina, M., Buttarelli, F. R., Ruggiero, A., Caldarelli, M., Poggi, G., Gandola, L., Pediatric intracranial ependymoma: correlating signs and symptoms at recurrence with outcome in the second prospective AIEOP protocol follow-up, <<JOURNAL OF NEURO-ONCOLOGY>>, 2018; 140 (2): 457-465. [doi:10.1007/s11060-018-2974-6] [http://hdl.handle.net/10807/148222]
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/10807/148222
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