Hypofractionated Stereotactic Radiation Therapy for Brain Metastases

Abstract

2011 were included. Neuropsychological assessments administered before and after radiation therapy measured total intelligence quotient (IQ). Parents were given Scales of Independent Behavior (SIB-R), a written questionnaire that assessed functional independence. Results: Median age at diagnosis was 38 months (range, 3 months 20 years). Nineteen (27%) patients had supratentorial ependymoma and 51 (73%) had infratentorial ependymoma. Forty-six (66%) had a gross total resection, and 24 (34%) had a subtotal resection. Thirty seven (53%) had anaplastic histology (WHO grade III); the remainder had classic ependymoma (WHO grade II). At a median follow-up of 46 months, 3year local control, progression free, and overall survival was 83%, 76% and 95%, respectively. Subtotal resection was significantly associated with worse progression-free survival (54% vs 88% for GTR; p Z 0$001) and overall survival (90% vs 97% for GTR; p Z 0$001). Anaplastic histology was observed with worse progression-free survival but did not reach statistical significance (69% vs 83% for classic; p Z 0$509). In a sub-set of patients (n Z 14), mean IQ was 108.5 at baseline and 111.3 after mean 2.05 years of follow-up. In a larger group of patients (n Z 28), overall SIB-R score was 100.1 at baseline and 100.8 after 2.21 years of follow-up. Few patients developed evidence of growth hormone deficiency (GHD), hypothyroidism or hearing loss. Conclusions: Outcomes for children treated with proton radiation compare favorably to the literature. Subtotal resection correlated with inferior outcome. The young age at diagnosis and the proximity of critical structures in patients with ependymoma make proton radiation therapy an ideal radiation modality. Author Disclosure: R. Sethi: None. B.Y. Yeap: None. R. Marino: None. K.J. Marcus: None. P. Caruso: None. M.B. Pulsifer: None. D. Ebb: None. N.J. Tarbell: L. Stock Options; ProCure (no current value to stocks). Q. Leadership; N.T.’s spouse is on the medical advisory board. T.I. Yock: None. S.M. MacDonald: None.