US Pharm. 2015;40(5):HS-32-HS-33.

Two research studies presented at the 3rd European Society for Radiotherapy and Oncology (ESTRO) Forum in Barcelona, Spain, demonstrate that increasing the dose of radiotherapy given to children with an intracranial ependymoma, a form of cancer of the central nervous system, can significantly improve their survival.

Malignant ependymoma, a cancer that develops in the cells that line the hollow cavities of the brain, is normally treated with a combination of surgery and radiotherapy, sometimes with the addition of chemotherapy. Since 2004, a dose of 59.4 Gy has been recommended for pediatric malignant ependymoma cases worldwide, as opposed to the lower (54 Gy) dose that was in use previously, and adding a radiotherapy boost to this can improve outcome yet further in selected cases.

Ependymoma is the third most common brain tumor in children. With surgery and radio therapy, the overall 5-year survival rate is approximately 70%, but individual prognoses differ considerably according to a number of factors—age, extent of surgery, and radiotherapy technique and dose.

Dr. Lorenza Gandola, head of the Paediatric Radiotherapy Unit at the Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy, and colleagues developed an innovative strategy for children who still had measurable intracranial ependymoma after surgery. In addition to the 59.4-Gy radiotherapy dose to the tumor bed, they added a boost of 8 Gy, divided into two fractions, to the tumor residue. To deliver the radiation dose directly to the remaining malignant tissue while sparing normal brain tissue as much as possible, the researchers used a combination of highly sophisticated radiotherapy techniques. Twenty-four eligible children (median age 4.5 years) out of the 143 in the Italian project received the radiotherapy boost, and 15 of them are still alive without disease progression at a median of 51 months after diagnosis.