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684Results of radiation therapy in the management of pineal region tumors
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682 RADIATION THERAPY FOR PINEAL REGION TUMORS. HS Erkal, M Serin, A Cakmak Ankara University Faculty of Medicine Department of Radiation Oncology, Ankara, Turkey Backm-ound : because of their low incidence and the evolution of diagnostic and therapeutic techniques, there exists no consensus on key management issues for pineal region tumors. M~terial and methods : medical reports of 50 cases of pineal region tumors, treated between 1976 and 1995, were retrospectively evaluated. There were 29 males and 21 females, their ages ranging from 3 to 59 years (median, 21 years). Tumor was localized in the pineal gland in 25 patients, the third ventricle in 19 and both in the pineal gland and the suprasellar region in 6. Subtotal resection was performed in 9 patients and biopsy in 8. Pinealoblastoma was diagnosed in 7 patients, germinoma in 4, malignant teratoma in 3, astrocytoma in 2 and pineocytoma in 1. Four patients received craniospinal, 25 partial brain and 21 whole brain radiotherapy. Four patients received adjuvant chemotherapy. Results : follow-up ranged from 0.2 to 18.3 years (median, 6.5 years). Overall survival rates at 5, 10 and 15 years were 56.2%, 47.8% and 47.8%, respectively. Progression-free survival rates at 5, 10 and 15 years were 56.3%, 50.2% and 50.2%, respectively. Overall and progression-free survival rates at 5 years were 58.3% and 43.1%, respectively, for patients with tissue diagnosis and 67.3% and 64.4% respectively, for patients without tissue diagnosis. Conclusion : although treatment for pineal region tumors should be based on tissue diagnosis, radiation therapy is effective in achieving local tumor control and improved survival rates in the absence of tissue diagnosis.
MEDULLA OBLONGATA AND PONTINE TUMOR IN CHILDHOOD. A REVIEW OF 33 CASES. Bernou A (1), Carrie C (I), Thiesse Ph (I), Negrier S (I), Mottolese C (2), Frappaz D (I), Bouffet E (1), Brunat Mentigny M (1) (I) Centre l.,6on B6rard, Lyon, France (2) H6pital Neurologique 69 Bron France. From January 1975 to December 1993, thirty-three children (sex ration M/F 1.6) with the diagnosis of medulla oblongata or pontine tumor were referred to the Centre LEon B6rard. The mean age was 6.5 years (range 2 months - 14 years). Surgical Biopsy was performed in 9 patients (4 grade I/II, 5 grade Ill-IV). Twenty-eight children received chemotherapy in addition of radiation therapy. One toxic death occurred after chemotherapy and prior to radiotherapy. The mean dose of radiation was 52 Gy. The mean time of survival was 10.8 months with a mean of follow-up was one year. All children died of disease. All relapses occurred into the radiotherapy field. Patterns of relapse and radiological modification after treatment will be discussed. Among all brainstem gliomas medulla oblongata and pontine tumors seem to have the worse outcome and so have to be studied separately from other brainstem tumors in prospective therapeutic trials.
684
685
RESULTS OF RADIATION THERAPY IN THE MANAGEMENT OF PINEAL REGION TUMORS.
RADIOTHERAPY FOR INTRACRANIAL AND SPINAL EPENDYMOMAS
Regueiro CA, de le Tone A, Ruiz MV, Veiasco J, Sanz MC, Valc&rcel FJ, MegalI6n R, and AragOn G. Dept Radiation Oncology. Clthice Puerta de Hierro. Madrid. Spain We have reviewed 51 patients Cots.) with newly diagnosed tumors of the pineal region treated at our department between January 1970 and June 1995. Twenty pts. had histological verification of tumor type prior to radiation, in 6 pts. the diagnosis of germ cell tumor was based on the presence of elevated tumor markers, 22 pts. were tested for redioesnsitivity with • dose of 20 Gy, and two pts. with non biopaled pineal tumors and another with non-biopsied multiple midnne tumors were treated with radiotherapy without evaluation of their rediosensitivity. Of the nine pts. with biopsy proven (BP) ectopic gerrninomes, 5 ere with no evidence of disease (NED), 2 developed isolated spinal relapses, one • local relapse and one patient was lost to follow-up. Three of the 4 pts. with pineal germinomas ere with NED and the other died of surgical complic=ttions before the end of the radiotherapy course. The 4 pts. with BP ptheoblastomas relapsed. One patient with a BP pineocytome remains free of disease. The patient with a BP grade 1 astrocytome relapsed locally and the patient with • BP multicentric non-germinoma germ cell tumor died of sepsis and hypematremie with no evidence of tumor relapse. One of the four pts. with pineal tumors and elevated tumor markers developed an isolated spinal relapse whose histopethologic eveluetion demonstrated • pinealoblestoma and another developed a intranranial meningeal relapse. One patient with a supraseller tumor and elevated tumor markers developed e second tumor (high grade gliome) 9 years after treefmenL The patient with multiple midline tumors and elevetad tumor markers is with NED. Ten of the nineteen pts. with pineal tumors who underwent • rediosensitJvity test failed to respond and were referred to the neurosurgery department. Of the nine pts. whose tumors responded, eight ere with NED and the other developed e second tumor (high grade gliome) 7 years after treatment. One of the two pts. with supreseller tumors tested for r e d i o s a n s ~ developed a isolated spinal relapse and the other is with NED. The patient with multiple midline tumors who was tested for rediosansit~ developed e systemic lymphome three months after treatmenL Of the two pts. with non-blopaied pineal tumors who did not undanNent the radlosensitivity test one failed locally and the other is NED. The patient with non-biopeied multiple midline tumors treated without evaluation of their radiosensith~ty is with NED.
Sch011er P.t, Schafer U.1, Micke O t, R0be Ch.~, Hampel G 1, Morgenroth C.z, Willich N~: WesfflUischeWilhelms-Unive~iUltMOnster,I Klinikund PoliklinikfOrStrahienthetapie - Radioonkologie,z Klinikund Poliklinikfor Neutochirurgie Background: Ependymomas are rare neuroectodermal tumors arising from the walls of the ventricles and the spinal canal. The optimal therapy concepts are still discussed. pumose: This retrospective study examines the results of radiation therapy for this rare entity. Materials & Methods: From 1961 to 1994, 22 patients were irradiated at our clinic for intracranial or spinal ependymomas. 11 tumors had a supratentorial location, 4 an infratentorial and 7 were located in the spinal canal. 5 patients did not undergo surgical treatment, 14 had a subtotal and 3 a total resection. Radiotherapy was carried out using a r..obalt-60 unit resp. a linear accelerator (X 10 MV) with a median total dose of 46.1 Gy. For 2 patients with intratentorial tumors, an additional irradiation of the neuroaxis with 35 Gy was applied. Results: The 5- and 10-year overall survival rates for all patients amounted to 47.6 %. Recurrence-free survival was 43.5 % at 5 years and 36.3 % at 10 years after therapy. In 8 cases, a complete remission (CR), in further 3 a partial remission (PR) could be achieved. 5 patients experienced no change of their disease (NC) and 6 patients progressed under therapy (PD). The neurologic symptoms were markedly reduced. Even for high radiation doses, no severe side effects (RTOG Ill/IV) could be noted. Conclusion: Our results and the comparison with literature indicate the importance of radiation therapy in the treatment of ependymomas as an effective treatment modality with little side effects.
682 RADIATION THERAPY FOR PINEAL REGION TUMORS. HS Erkal, M Serin, A Cakmak Ankara University Faculty of Medicine Department of Radiation Oncology, Ankara, Turkey Backm-ound : because of their low incidence and the evolution of diagnostic and therapeutic techniques, there exists no consensus on key management issues for pineal region tumors. M~terial and methods : medical reports of 50 cases of pineal region tumors, treated between 1976 and 1995, were retrospectively evaluated. There were 29 males and 21 females, their ages ranging from 3 to 59 years (median, 21 years). Tumor was localized in the pineal gland in 25 patients, the third ventricle in 19 and both in the pineal gland and the suprasellar region in 6. Subtotal resection was performed in 9 patients and biopsy in 8. Pinealoblastoma was diagnosed in 7 patients, germinoma in 4, malignant teratoma in 3, astrocytoma in 2 and pineocytoma in 1. Four patients received craniospinal, 25 partial brain and 21 whole brain radiotherapy. Four patients received adjuvant chemotherapy. Results : follow-up ranged from 0.2 to 18.3 years (median, 6.5 years). Overall survival rates at 5, 10 and 15 years were 56.2%, 47.8% and 47.8%, respectively. Progression-free survival rates at 5, 10 and 15 years were 56.3%, 50.2% and 50.2%, respectively. Overall and progression-free survival rates at 5 years were 58.3% and 43.1%, respectively, for patients with tissue diagnosis and 67.3% and 64.4% respectively, for patients without tissue diagnosis. Conclusion : although treatment for pineal region tumors should be based on tissue diagnosis, radiation therapy is effective in achieving local tumor control and improved survival rates in the absence of tissue diagnosis.
MEDULLA OBLONGATA AND PONTINE TUMOR IN CHILDHOOD. A REVIEW OF 33 CASES. Bernou A (1), Carrie C (I), Thiesse Ph (I), Negrier S (I), Mottolese C (2), Frappaz D (I), Bouffet E (1), Brunat Mentigny M (1) (I) Centre l.,6on B6rard, Lyon, France (2) H6pital Neurologique 69 Bron France. From January 1975 to December 1993, thirty-three children (sex ration M/F 1.6) with the diagnosis of medulla oblongata or pontine tumor were referred to the Centre LEon B6rard. The mean age was 6.5 years (range 2 months - 14 years). Surgical Biopsy was performed in 9 patients (4 grade I/II, 5 grade Ill-IV). Twenty-eight children received chemotherapy in addition of radiation therapy. One toxic death occurred after chemotherapy and prior to radiotherapy. The mean dose of radiation was 52 Gy. The mean time of survival was 10.8 months with a mean of follow-up was one year. All children died of disease. All relapses occurred into the radiotherapy field. Patterns of relapse and radiological modification after treatment will be discussed. Among all brainstem gliomas medulla oblongata and pontine tumors seem to have the worse outcome and so have to be studied separately from other brainstem tumors in prospective therapeutic trials.
684
685
RESULTS OF RADIATION THERAPY IN THE MANAGEMENT OF PINEAL REGION TUMORS.
RADIOTHERAPY FOR INTRACRANIAL AND SPINAL EPENDYMOMAS
Regueiro CA, de le Tone A, Ruiz MV, Veiasco J, Sanz MC, Valc&rcel FJ, MegalI6n R, and AragOn G. Dept Radiation Oncology. Clthice Puerta de Hierro. Madrid. Spain We have reviewed 51 patients Cots.) with newly diagnosed tumors of the pineal region treated at our department between January 1970 and June 1995. Twenty pts. had histological verification of tumor type prior to radiation, in 6 pts. the diagnosis of germ cell tumor was based on the presence of elevated tumor markers, 22 pts. were tested for redioesnsitivity with • dose of 20 Gy, and two pts. with non biopaled pineal tumors and another with non-biopsied multiple midnne tumors were treated with radiotherapy without evaluation of their rediosensitivity. Of the nine pts. with biopsy proven (BP) ectopic gerrninomes, 5 ere with no evidence of disease (NED), 2 developed isolated spinal relapses, one • local relapse and one patient was lost to follow-up. Three of the 4 pts. with pineal germinomas ere with NED and the other died of surgical complic=ttions before the end of the radiotherapy course. The 4 pts. with BP ptheoblastomas relapsed. One patient with a BP pineocytome remains free of disease. The patient with a BP grade 1 astrocytome relapsed locally and the patient with • BP multicentric non-germinoma germ cell tumor died of sepsis and hypematremie with no evidence of tumor relapse. One of the four pts. with pineal tumors and elevated tumor markers developed an isolated spinal relapse whose histopethologic eveluetion demonstrated • pinealoblestoma and another developed a intranranial meningeal relapse. One patient with a supraseller tumor and elevated tumor markers developed e second tumor (high grade gliome) 9 years after treefmenL The patient with multiple midline tumors and elevetad tumor markers is with NED. Ten of the nineteen pts. with pineal tumors who underwent • rediosensitJvity test failed to respond and were referred to the neurosurgery department. Of the nine pts. whose tumors responded, eight ere with NED and the other developed e second tumor (high grade gliome) 7 years after treatment. One of the two pts. with supreseller tumors tested for r e d i o s a n s ~ developed a isolated spinal relapse and the other is with NED. The patient with multiple midline tumors who was tested for rediosansit~ developed e systemic lymphome three months after treatmenL Of the two pts. with non-blopaied pineal tumors who did not undanNent the radlosensitivity test one failed locally and the other is NED. The patient with non-biopeied multiple midline tumors treated without evaluation of their radiosensith~ty is with NED.
Sch011er P.t, Schafer U.1, Micke O t, R0be Ch.~, Hampel G 1, Morgenroth C.z, Willich N~: WesfflUischeWilhelms-Unive~iUltMOnster,I Klinikund PoliklinikfOrStrahienthetapie - Radioonkologie,z Klinikund Poliklinikfor Neutochirurgie Background: Ependymomas are rare neuroectodermal tumors arising from the walls of the ventricles and the spinal canal. The optimal therapy concepts are still discussed. pumose: This retrospective study examines the results of radiation therapy for this rare entity. Materials & Methods: From 1961 to 1994, 22 patients were irradiated at our clinic for intracranial or spinal ependymomas. 11 tumors had a supratentorial location, 4 an infratentorial and 7 were located in the spinal canal. 5 patients did not undergo surgical treatment, 14 had a subtotal and 3 a total resection. Radiotherapy was carried out using a r..obalt-60 unit resp. a linear accelerator (X 10 MV) with a median total dose of 46.1 Gy. For 2 patients with intratentorial tumors, an additional irradiation of the neuroaxis with 35 Gy was applied. Results: The 5- and 10-year overall survival rates for all patients amounted to 47.6 %. Recurrence-free survival was 43.5 % at 5 years and 36.3 % at 10 years after therapy. In 8 cases, a complete remission (CR), in further 3 a partial remission (PR) could be achieved. 5 patients experienced no change of their disease (NC) and 6 patients progressed under therapy (PD). The neurologic symptoms were markedly reduced. Even for high radiation doses, no severe side effects (RTOG Ill/IV) could be noted. Conclusion: Our results and the comparison with literature indicate the importance of radiation therapy in the treatment of ependymomas as an effective treatment modality with little side effects.