PMID- 32072441
OWN - NLM
STAT- MEDLINE
DCOM- 20210202
LR  - 20210319
IS  - 1573-7373 (Electronic)
IS  - 0167-594X (Linking)
VI  - 147
IP  - 2
DP  - 2020 Apr
TI  - Extent of re-excision, sequence/timing of salvage re-irradiation, and 
      disease-free interval impact upon clinical outcomes in recurrent/progressive 
      ependymoma.
PG  - 405-415
LID - 10.1007/s11060-020-03434-7 [doi]
AB  - PURPOSE: To report clinical outcomes of salvage re-irradiation (re-RT) in 
      recurrent/progressive ependymoma. METHODS: Medical records of patients treated 
      with curative-intent re-RT as multi-modality management for recurrent/progressive 
      ependymoma were analyzed retrospectively. The linear-quadratic model was used to 
      provide estimates of biologically effective dose (BED) of irradiation using an 
      alpha/beta value of 2 for late CNS toxicity for each course of irradiation and summated 
      to derive cumulative BED without correcting for the assumed recovery. RESULTS: A 
      total of 55 patients (median age 10 years at index diagnosis) treated with 
      curative-intent re-RT between 2010 and 2018 were included. Median time to first 
      recurrence was 29 months with an inter-quartile range (IQR) of 16-64 months. 
      Majority (n = 46, 84%) of patients underwent surgical re-excision of recurrent 
      disease. Median interval from first course of irradiation (RT1) to second course 
      (RT2) was 35 months (IQR = 26-66 months) with a median re-RT dose of 54 Gy in 30 
      fractions (range 40-60 Gy), resulting in median cumulative equivalent dose in 
      2 Gy fraction (EQD2) of 106.2 Gy (range 92.4-117.6 Gy). Volume of re-RT was based 
      on location and pattern of relapse, comprising uni-focal (n = 49, 89%), 
      multi-focal (n = 3, 5.5%), or craniospinal irradiation (CSI) in 3 (5.5%) patients 
      respectively. Thirty-six (66%) patients received platinum-based salvage 
      chemotherapy either before or after RT2. At a median follow up of 37 months 
      (range 6-80 months), the Kaplan-Meier estimates of 3-year progression-free 
      survival (PFS) and overall survival (OS) for the entire study cohort were 40% and 
      51% respectively. Gross total resection at recurrence; early salvage re-RT (prior 
      to chemotherapy, if any); and longer (> 2 years) disease-free interval (DFI) were 
      associated with better survival outcomes. Salvage re-RT was generally well 
      tolerated with only 3 (5.5%) patients developing symptomatic radiation necrosis 
      necessitating corticosteroids. CONCLUSION: Extent of re-excision, sequence/timing 
      of re-RT, and DFI impact upon outcomes in curative-intent, multi-modality salvage 
      therapy for recurrent ependymoma.
FAU - Gupta, Tejpal
AU  - Gupta T
AUID- ORCID: 0000-0001-8256-9206
AD  - Departments of Radiation Oncology, Advanced Centre for Treatment Research & 
      Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, 
      Mumbai, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, 
      India. tejpalgupta@rediffmail.com.
FAU - Maitre, Madan
AU  - Maitre M
AD  - Departments of Radiation Oncology, Advanced Centre for Treatment Research & 
      Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, 
      Mumbai, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, 
      India.
FAU - Gupta, Priyamvada
AU  - Gupta P
AD  - Departments of Radiation Oncology, Advanced Centre for Treatment Research & 
      Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, 
      Mumbai, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, 
      India.
FAU - Krishnatry, Rahul
AU  - Krishnatry R
AD  - Departments of Radiation Oncology, Advanced Centre for Treatment Research & 
      Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, 
      Mumbai, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, 
      India.
FAU - Chatterjee, Abhishek
AU  - Chatterjee A
AD  - Departments of Radiation Oncology, Advanced Centre for Treatment Research & 
      Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, 
      Mumbai, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, 
      India.
FAU - Moiyadi, Aliasgar
AU  - Moiyadi A
AD  - Departments of Neuro-Surgical Oncology, Advanced Centre for Treatment Research & 
      Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, 
      Mumbai, Homi Bhabha National Institute (HBNI), Mumbai, India.
FAU - Shetty, Prakash
AU  - Shetty P
AD  - Departments of Neuro-Surgical Oncology, Advanced Centre for Treatment Research & 
      Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, 
      Mumbai, Homi Bhabha National Institute (HBNI), Mumbai, India.
FAU - Singh, Vikas
AU  - Singh V
AD  - Departments of Neuro-Surgical Oncology, Advanced Centre for Treatment Research & 
      Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, 
      Mumbai, Homi Bhabha National Institute (HBNI), Mumbai, India.
FAU - Chinnaswamy, Girish
AU  - Chinnaswamy G
AD  - Departments of Pediatric Oncology, Advanced Centre for Treatment Research & 
      Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, 
      Mumbai, Homi Bhabha National Institute (HBNI), Mumbai, India.
FAU - Epari, Sridhar
AU  - Epari S
AD  - Departments of Pathology, Advanced Centre for Treatment Research & Education in 
      Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Mumbai, Homi 
      Bhabha National Institute (HBNI), Mumbai, India.
FAU - Sahay, Ayushi
AU  - Sahay A
AD  - Departments of Pathology, Advanced Centre for Treatment Research & Education in 
      Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, Mumbai, Homi 
      Bhabha National Institute (HBNI), Mumbai, India.
FAU - Patil, Vijay
AU  - Patil V
AD  - Departments of Medical Oncology, Advanced Centre for Treatment Research & 
      Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, 
      Mumbai, Homi Bhabha National Institute (HBNI), Mumbai, India.
FAU - GodaSastri, Jayant
AU  - GodaSastri J
AD  - Departments of Radiation Oncology, Advanced Centre for Treatment Research & 
      Education in Cancer (ACTREC)/Tata Memorial Hospital (TMH), Tata Memorial Centre, 
      Mumbai, Homi Bhabha National Institute (HBNI), Kharghar, Navi Mumbai, 410210, 
      India.
LA  - eng
PT  - Journal Article
DEP - 20200218
PL  - United States
TA  - J Neurooncol
JT  - Journal of neuro-oncology
JID - 8309335
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Brain Neoplasms/*mortality/pathology/radiotherapy/surgery
MH  - Child
MH  - Child, Preschool
MH  - Combined Modality Therapy
MH  - Craniospinal Irradiation/*mortality
MH  - Ependymoma/*mortality/pathology/radiotherapy/surgery
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Infant
MH  - Male
MH  - Middle Aged
MH  - Neoplasm Recurrence, Local/*mortality/pathology/radiotherapy/surgery
MH  - Neurosurgical Procedures/*mortality
MH  - Prognosis
MH  - Re-Irradiation/*mortality
MH  - Retrospective Studies
MH  - *Salvage Therapy
MH  - Survival Rate
MH  - Young Adult
OTO - NOTNLM
OT  - Chemotherapy
OT  - Ependymoma
OT  - Re-irradiation
OT  - Recurrence
OT  - Resection
EDAT- 2020/02/20 06:00
MHDA- 2021/02/03 06:00
CRDT- 2020/02/20 06:00
PHST- 2020/01/02 00:00 [received]
PHST- 2020/02/13 00:00 [accepted]
PHST- 2020/02/20 06:00 [pubmed]
PHST- 2021/02/03 06:00 [medline]
PHST- 2020/02/20 06:00 [entrez]
AID - 10.1007/s11060-020-03434-7 [pii]
AID - 10.1007/s11060-020-03434-7 [doi]
PST - ppublish
SO  - J Neurooncol. 2020 Apr;147(2):405-415. doi: 10.1007/s11060-020-03434-7. Epub 2020 
      Feb 18.