RADIATION THERAPY immediately following surgery in children with ependymoma, the third most common pediatric brain tumor, nearly tripled survival, in a Children’s Oncology Group (COG) clinical trial led by Thomas E. Merchant, DO, PhD, Chair of the Department of Radiation Oncology at St. Jude Children’s Research Hospital. The findings appeared as an advance online publication in the Journal of Clinical Oncology.1
Thomas E. Merchant, DO, PhD
“Historically, children under the age of 3 with ependymoma have a worse prognosis than older children,” said Dr. Merchant, principal investigator of the study. “However, results from this clinical trial show that, even in young children, survival can be improved when radiation is administered immediately after surgery.”
THE PHASE II COG clinical trial was the first cooperative group study to give immediate postoperative radiation to children under age three with ependymoma. The clinical trial was open at more than 100 locations and enrolled nearly 400 patients.
The study included both infratentorial ependymoma and the rarer supratentorial ependymoma. Participants ranged in age from 1 to 21 years old and were followed after treatment to evaluate the long-term effects of care. The results showed that postoperative radiation therapy may help achieve 7-year progression-free survival for more than 75% of patients and overall survival for 85% of patients. The findings provided evidence that radiation therapy may improve outcomes for pediatric patients despite age and ependymoma subtype.
Maryam Fouladi, MD
“These results are already shifting the standard of care for patients with ependymoma, because the clinical trial used standard conformal radiation, which is widely available,” said Maryam Fouladi, MD, Chair of the COG Central Nervous System Committee.
THE PRIMARY GOAL of the clinical trial was to evaluate the effectiveness of postoperative radiation for children with ependymoma. However, the researchers also conducted molecular analyses to study the underlying biology of this disease and determine the significance of certain biologic markers in regard to patient outcomes. The study showed that for patients with either ependymoma subtype, regardless of genetic markers that were previously thought to predict worse outcomes, patients can do equally well with surgery followed immediately by radiation therapy.
That said, molecular analyses did reveal that chromosome 1q increases the risk of tumor progression, solidifying 1q as a poor prognostic biomarker for ependymoma. ■
DISCLOSURE: For full disclosures of the study authors, visit www.jco.ascopubs.org.
1. Merchant TE, Bendel AE, Sabin ND, et al: Conformal radiation therapy for pediatric ependymoma, chemotherapy for incompletely resected ependymoma, and observation for completely resected, supratentorial ependymoma. J Clin Oncol. February 27, 2019 (early release online).