Outcome of teenagers and young adults with ependymoma: The Royal Marsden experience
Tóm tắt
The outcome and clinical characteristics of teenagers and young adults (TYA) with ependymoma have not been well documented. We report the Royal Marsden Hospital experience treating TYA with ependymoma. Sixteen TYA were treated for ependymoma from 1971 to 2004 and are compared to 24 children (not infants) treated in the same period. Twelve TYA (75%) received treatment in a neuro-oncology unit. Average time from symptoms to diagnosis was 183 days for TYA vs. 61.2 for children (p = 0.005). Two TYA (12.5% vs. 41.6% for children, p = 0.08) were enrolled in a clinical trial. Only 25% of TYA achieved gross total resection, all of them received radiotherapy and five of them received chemotherapy. There were five relapses; all of them were local. Five-year overall survival was 84.6% ± 10 for TYA vs. 78.1% ± 8.7 for children (p = 0.15), and 5-year progression-free survival was 66.6% ± 12.3 for TYA vs. 44.4% ± 10.3 for children (p = 0.08). Up to 56% of patients treated in the paediatric unit received psychosocial support vs. 42.9% of patients treated in the adult unit. Ependymoma in adolescents and young adults is an infrequent entity, with perhaps better outcome compared to children. The extent of surgical resection as seen in children is an important prognostic factor. Providing adolescents with ependymoma the appropriate neuro-oncologic care, including access to multidisciplinary teams, full access to clinical trials and age-appropriate neuro-oncologic ancillary support services, remains a challenge.
Tài liệu tham khảo
Birch JM, Pang D, Alston RD, Rowan S, Geraci M, Moran A, Eden TO (2008) Survival from cancer in teenagers and young adults in England, 1979–2003. Br J Cancer 99:830–835
Bleyer A, Budd T, Montello M (2006) Adolescents and young adults with cancer: the scope of the problem and criticality of clinical trials. Cancer 107:1645–1655
Gatta G, Capocaccia R, De AR, Stiller C, Coebergh JW (2003) Cancer survival in European adolescents and young adults. Eur J Cancer 39:2600–2610
Bleyer A, Viny A, Barr R (2006) Cancer in 15- to 29-year-olds by primary site. Oncologist 11:590–601
Capra M, Hargrave D, Bartels U, Hyder D, Huang A, Bouffet E (2003) Central nervous system tumours in adolescents. Eur J Cancer 39:2643–2650
Reni M, Gatta G, Mazza E, Vecht C (2007) Ependymoma. Crit Rev Oncol Hematol 63:81–89
West CR, Bruce DA, Duffner PK (1985) Ependymomas. Factors in clinical and diagnostic staging. Cancer 56:1812–1816
Berrino F (2003) The EUROCARE Study: strengths, limitations and perspectives of population-based, comparative survival studies. Ann Oncol 14(Suppl 5):v9–13
Gatta G, Corazziari I, Magnani C, Peris-Bonet R, Roazzi P, Stiller C (2003) Childhood cancer survival in Europe. Ann Oncol 14(Suppl 5):v119–v127
Taylor MD, Poppleton H, Fuller C, Su X, Liu Y, Jensen P, Magdaleno S, Dalton J, Calabrese C, Board J, Macdonald T, Rutka J, Guha A, Gajjar A, Curran T, Gilbertson RJ (2005) Radial glia cells are candidate stem cells of ependymoma. Cancer Cell 8:323–335
Jaing TH, Wang HS, Tsay PK, Tseng CK, Jung SM, Lin KL, Lui TN (2004) Multivariate analysis of clinical prognostic factors in children with intracranial ependymomas. J Neurooncol 68:255–261
Martin S, Ulrich C, Munsell M, Taylor S, Lange G, Bleyer A (2007) Delays in cancer diagnosis in underinsured young adults and older adolescents. Oncologist 12:816–824
Bleyer A (2007) Young adult oncology: the patients and their survival challenges. CA Cancer J Clin 57:242–255
Bleyer WA, Tejeda H, Murphy SB, Robison LL, Ross JA, Pollock BH, Severson RK, Brawley OW, Smith MA, Ungerleider RS (1997) National cancer clinical trials: children have equal access; adolescents do not. J Adolesc Health 21:366–373
Ferrari A, Dama E, Pession A, Rondelli R, Pascucci C, Locatelli F, Ferrari S, Mascarin M, Merletti F, Masera G, Arico M, Pastore G (2009) Adolescents with cancer in Italy: entry into the national cooperative paediatric oncology group AIEOP trials. Eur J Cancer 45:328–334