Adjuvant Radiation Therapy on Outcomes of G2 Localized Intracranial Ependymoma: A Single Lower-Middle-Income Country Center Report

Abstract

Author(s): Mohamed Saad Zaghloul1,2, Eman Eldebawy1, Amal Refaat3,4, Hala Taha5,6, Marwa Magdy5,6, Mohamed El Beltagy7,8, Marwa Aboalsoud9*

Aim: This study aimed to evaluate the impact of ART on survival outcomes in G2 ependymomas, as well as to identify key prognostic factors in children treated at a single institution in a lower-middle-income country (LMIC). Methods: A retrospective study included 131 children with pathologically confirmed grade 2 intracranial ependymoma treated in a single LMIC institution. Children were diagnosed between January 2008 and December 2022. Approval of Scientific and Medical Advisory Committee (SMAC) and the Institutional Review Board (IRB) was obtained. Results: After a median follow-up of 3.7 years, 81.7% were alive, and 70.2% were free of disease. The 5-year event-free survival (EFS) rate was 69% of those who received ART, compared with 57% in those who received surgery alone (P = 0.017). Gross total resection (GTR) was associated with a higher 5-year overall survival (OS) of 85% compared with 64% for subtotal resection (STR) (p=0.045). The 5-year EFS was the highest for children who underwent GTR and received ART. (74% vs 59%, P=0.008). There was no significant difference between ART dose of 5400 and 5940 cGy (p=0.872). The multivariate analysis revealed that total resection and the use of ART were the only independent prognostic factors determining EFS. The overall survival (OS), although higher with ART, did not reach statistical significance (p = 0.1). The RT adverse effects were tolerable without any grade 3 toxicity. Conclusion: ART and GTR are essential to achieve significantly higher EFS. The beneficial effect of ART on EFS remained significant even after GTR. The results showed the availability for LMICs to reach similar levels of results achieved by high-income countries.

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