Phase II study of pre‐irradiation chemotherapy for childhood intracranial ependymoma. Children's Cancer Group protocol 9942: A report from the Children's Oncology Group

Abstract

Children with near total resection of ependymoma may benefit from pre-irradiation chemotherapy. Patients with subtotal resection have inferior outcome despite responses to chemotherapy, and should be considered for second-look surgery prior to irradiation. Pediatr Blood Cancer 2012; 59: 1183-1189. © 2012 Wiley Periodicals, Inc.

Oncological Management of Ependymomas

“…In between two surgeries, there is no defi nitive indication for chemotherapy since most of the regimens tested have not shown many responses [ 2 ]. Pre-irradiation chemotherapy may compensate for an incomplete resection as it has been shown with a recently published phase II using a standard chemotherapy regimen based on cisplatin in patients with incompletely resected; in this report, patients with incompletely resected ependymomas treated with pre-irradiation chemotherapy had similar although slightly lower EFS than those with completely resected ependymomas treated with irradiation only [ 3 ]. In addition, some anecdotal reports have shown that second surgery may be facilitated by a course or two of…”

A headache presenting in the emergency room, a clinical manifestation of an unfortunate diagnosis (grade III left frontal anaplastic ependymoma with 1p deletion)

“…Major studies have been conducted in children using more effective agents such as etoposide, carboplatin and cisplatin 9. A cooperative group study has demonstrated, with 32 patients, a 40% complete response to preradiation chemotherapy, while 14% demonstrated progressive tumour growth 15. There was 5-year overall survival rate of 71% for all patients 9.…”

Estudo das alterações na expressão gênica dos ependimomas

“…A taxa de resposta dos ependimomas a agentes únicos é de 11%, com menos que 5% dos casos mostrando resposta completa (Bouffet and Foreman 1999). Cisplatina mostrou ser o agente mais ativo dos quimioterápicos únicos já testados (Khan, D'Souza et al 1982;Sexauer, Khan et al 1985;Walker and Allen 1988;Goldwein, Glauser et al 1990;Grundy, Wilne et al 2007;Garvin, Selch et al 2012). Naqueles raros pacientes que respondem à quimioterapia, não há um aumento significativo da sobrevida, mesmo nos casos submetidos à quimioterapia em associação ou em adição à radioterapia (Needle, Goldwein et al 1997;Robertson, Zeltzer et al 1998;Timmermann, Kortmann et al 2000).…”

“…Naqueles raros pacientes que respondem à quimioterapia, não há um aumento significativo da sobrevida, mesmo nos casos submetidos à quimioterapia em associação ou em adição à radioterapia (Needle, Goldwein et al 1997;Robertson, Zeltzer et al 1998;Timmermann, Kortmann et al 2000). Os estudos prospectivos com vários esquemas de quimioterapia também falham em mostrar resultados efetivos (Reni, Gatta et al 2007;Zacharoulis and Moreno 2009;Garvin, Selch et al 2012;Gururangan, Fangusaro et al 2012;Wright and Gajjar 2012).…”

“…A quimioterapia em crianças menores de 5 anos é utilizada como tentativa de postergar a radioterapia e tentar evitar os efeitos deletérios tardios do seu uso no encéfalo em desenvolvimento (Donahue 1992;Constine, Woolf et al 1993;Grill, Le Deley et al 2001;Mulhern, Merchant et al 2004;Merchant, Kiehna et al 2005;Grundy, Wilne et al 2007;von Hoff, Kieffer et al 2008;Bouffet, Tabori et al 2009;Zacharoulis and Moreno 2009;Garvin, Selch et al 2012). O uso de agentes-alvo baseados no padrão molecular do tumor ainda é pouco estudado e sem resultado efetivo (Wright and Gajjar 2009;Atkinson, Shelat et al 2011;Shonka 2011;Benesch, Frappaz et al 2012).…”