paediatrics Brussels 17

J Neurooncol (2006)

were 86% and 46%, respectively ( P = 0.03). Regarding the extent of surgery, the 10-year LC rate for patients who had GTR with and without adjuvant RT were 90% and 58%, respectively ( P = 0.01). The LC rate for patients who underwent STR plus adjuvant RT was 90% at 10 years, whereas two patients who had STR alone experienced local recurrence. Table 2 shows the primary tumor site and the initial and salvage treatments used. All 12 recurrences were in the neural axis, and most were within the primary site. Overall, eight patients had failures within the primary site alone, three in the distant neural axis only, and one at the primary site and in the distant neural axis. Regarding the extent of surgery, disease recur- rence was experienced by 5 (45%) of 11 patients who had GTR alone, 1 (10%) of 10 patients who had GTR plus adjuvant RT, 2 (100%) of 2 patients treated with STR alone, and 4 (33%) of 12 patients treated with STR plus adjuvant RT. Of the 12 patients, 8 (67%) with treatment failures underwent successful salvage therapy with further surgery, RT, and/or chemotherapy (2 patients re- ceived oral 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosurea (CCNU) 130 mg/m 2 monthly for 12 courses, one received intrathecal mafosfamide 5 mg monthly for 18 courses, and one received oral procarbazine 125 mg/m 2 monthly for 6 courses). Three of these patients were alive with disease at last follow-up, at 4–21 years following their relapse. All patients tolerated RT completing their prescribed therapy without interruption. The median follow-up time for patients undergoing adjuvant RT was 11.5 years (range, 2.9–33 years). Before adjuvant RT, 7 patients (32%) were classified as Frankel grade E, 13 patients (59%) as grade D, and 2 patients (9%) as grade C. There was no patient classified as grade A or B before adjuvant RT. Ten patients (45%) maintained their pretreatment neurological status up to the last follow-up visit (7 patients were grade E, 2 were grade D and 1 was grade C). Eleven patients (50%) experi- enced improved neurologic function after treatment (10 patients changed from grade D to E, 1 patient from grade C to D). One patient (5%) with grade D changed to grade B after multiple surgeries for tumor progres- sion (Fig. 4). Patterns of failure Neurologic functional outcome after adjuvant RT

100

75

50

Proportion

25

0

10

0

5

15

Years

28

21

9

No. At Risk: 35

Fig. 1 Overall survival for the entire group

100

75

50

Proportion

25

0

10

0

5

15

Years

19

13

5

No. At Risk: 35

Fig. 2 Progression-free survival for the entire group

100

75

Surgery& Adjuvant RT

50

Surgery Alone

25 Proportion

p = 0.04

0

0

5

10

15

No. At Risk: Surgery Alone Surgery+AdjRT

Years

13 22

5

2

1 5

15

12

Fig. 3 Progression-free survival according to initial treatment groups (i.e., surgery alone vs. surgery and adjuvant radiotherapy, P = 0.04)

75%, respectively, and for those treated by any surgery alone 49% and 37%, respectively. Adjuvant radiation was associated with higher LC. The 10-year LC rates with or without adjuvant RT

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