OP24ASSESSING 'SECOND-LOOK' TUMOUR RESECTABILITY IN CHILDHOOD EPENDYMOMA - A CENTRALISED REVIEW PANEL AND CLASSIFICATION TOOL FOR THE SIOP EPENDYMOMA II TRIAL

Abstract

INTRODUCTION: Complete surgical resection is significantly associated with survival in most, but not all clinical trials in Ependyoma, and varies significantly due to surgical strategy. To improve imaging quality and discussion of surgical resection status in the forthcoming SIOP Ependymoma II trial, a central review of imaging and resection status will be offered prior to treatment stratification. We present a review of surgical decision-making from the UKCCSG/SIOP Ependymoma trial along with a primary surgical classification system for Ependymoma II. METHOD: Imaging of 89 patients enrolled in the UKCCSG/SIOP Ependymoma trial was independently reviewed by 3 experienced paediatric neuro-oncology surgeons (44 incomplete, 45 complete). 6 incomplete resections were supratentorial and data was incomplete for 10. Pre and post op imaging was only available for 28 posterior fossa cases. Location of residual disease, decision to offer 'second-look' surgery, perceived chance of complete resection, and risk to cranial nerves was assessed. Review panel retrospective recommendation for 'second-look' surgery was compared with actual 'second-look' surgery for patients with incomplete resections after initial surgery. RESULTS: 28 patients with incomplete resections were reviewed. 13 patients had 'second-look' surgery at some point. Of the remaining 15 patients, the surgical review panel would have offered 'second-look' surgery in 9 of these, and 18 overall. CONCLUSION: Based on scans alone a surgical panel would have offered 'second-look' surgery to an additional 53% of patients. The benefit of a surgical review panel and classification system will be assessed in the forthcoming Ependyoma II trial to maximise complete resection whilst minimising surgical morbidity.