levoleucovorin and Ependymoma

Ependymomas represent 10% of pediatric brain tumors. In the recent WHO 2016 classification, pathology is enriched by localization and molecular biology. Whatever the age, total removal by one or several looks when required remains a major prognostic factor. In children, focal radiation remains a standard, while the role of chemotherapy is matter of randomized studies. In infants, front line chemotherapy is the standard. Inclusion in the SIOP ependymoma II protocol is encouraged. In case of relapse, further surgery and radiation are advised, while inclusion in innovative trials including re-irradiation, and phase I-II should be encouraged. A better understanding of underlying mechanisms of ependymoma cell will provide in the close future, the key to use targeted therapies at time of relapse, and very soon as first line therapy for some subgroups of patients.

Topics: Antineoplastic Combined Chemotherapy Protocols; Brain Neoplasms; Child; Ependymoma; Humans; Infant; Leucovorin; Methotrexate; Neoplasm Recurrence, Local; Procarbazine; Prognosis; Rare Diseases; Vincristine

This study investigates the outcome of children <10 years old with newly-diagnosed ependymoma treated on the prospective multinational "Head Start" III clinical trial. Between April 2004 and July 2009, 19 children with newly-diagnosed ependymoma were enrolled. All children were to receive five induction chemotherapy cycles followed by one consolidation cycle of myelo-ablative chemotherapy and autologous hematopoietic cell rescue. Children between 6 and 10 years of age or with residual tumor prior to consolidation were to receive irradiation thereafter. Median age of 19 children (8 female) was 20 months at diagnosis. Median follow up was 44 months. The primary site was infratentorial in 11 and supratentorial in 8 patients. Gross total resection was achieved in 10 patients. After induction chemotherapy, all three supratentorial ependymoma patients with residual disease achieved a complete response (CR), while only one of six infratentorial patients with residual disease achieved CR. Three infratentorial patients developed progressive disease during induction chemotherapy. All four infratentorial patients with residual disease who underwent autologous hematopoietic cell transplant, failed to achieve CR. Four patients received focal irradiation following chemotherapy. The 3-year event free survival (EFS) and overall survival (OS) for supratentorial ependymoma were 86 ± 13 % and 100 % respectively. The 3-year EFS and OS for infratentorial ependymoma were 27 ± 13 % and 73 ± 13 % respectively. The role of intensive induction and consolidation chemotherapy in deferring irradiation should be investigated further in children with supratentorial ependymoma with residual disease following surgery. This approach appears ineffective in children with infratentorial ependymoma in the absence of irradiation.

Topics: Antineoplastic Combined Chemotherapy Protocols; Brain Neoplasms; Child; Child, Preschool; Cisplatin; Combined Modality Therapy; Cyclophosphamide; Ependymoma; Etoposide; Female; Follow-Up Studies; Humans; Leucovorin; Male; Methotrexate; Prognosis; Prospective Studies; Radiotherapy Dosage; Survival Rate; Vincristine

Changes in bone marrow status followig cytotoxic chemotherapy were measured by means of peripheral blood counts, bone marrow cytology and colony-formation in agar culture. A correlation is described between colony-forming ability and marrow differential count.

Topics: Adult; Agar; Blood Cell Count; Bone Marrow; Bone Marrow Cells; Cerebral Ventricle Neoplasms; Chlorobenzenes; Clone Cells; Ependymoma; Female; Granulocytes; Humans; Leucovorin; Pyrimidines

Topics: Animals; Brain; Carbon Isotopes; Ependymoma; Extracellular Space; Half-Life; Inulin; Kinetics; Leucovorin; Methotrexate; Mice; Mice, Inbred Strains; Neoplasms, Experimental; Protein Binding; Serum Albumin; Tetrahydrofolate Dehydrogenase; Tritium

Topics: Adolescent; Brain; Brain Neoplasms; Child; Ependymoma; Femoral Neoplasms; Humans; Injections, Spinal; Leucovorin; Male; Methotrexate; Neoplasm Metastasis