It's never too early.

Top Line: Oh boy. The big pediatric ependymoma trial ACNS0121 is out and is jam-packed with data.
The Study: The big highlights are its investigation of immediate radiation in younger kids (<3 years), reduced radiation volumes, and chemo for those with subtotal resection. All kids (1-21 years) with nonmetastatic ependymoma were eligible. Among these, 60% were classic histology, and 73% were infratentorial. The majority (82%) had at least “near-total” resections with ≤0.5 cm of residual disease. Patients with completely-resected supratentorial tumors were observed—of note, almost 80% of these had RELA-fusions portending worse prognosis yet still went on to have excellent outcomes. Patients with any near-total resection or with completely-resected infratentorial tumors received “conformal” post-op radiation. The GTV consisted of the tumor + tumor bed, and the CTV was a 1 cm anatomic expansion. Patients over 18 months received 59.4 Gy while younger(!) kids received 54 Gy. Among young patients who would have previously had delayed radiation, overall survival (87%) and event-free survival (63%) were much higher than historical controls and similar to that of older kids. Outcomes were fairly similar with complete versus near-total resection with local control rates of 75-80% across the board.
Bottom Line: For ependymoma, immediate radiation for kids 1-3 years old resulted in disease outcomes comparable to older kids, and conformal post-op radiation volumes achieved excellent local control. | Merchant, J Clin Oncol 2019


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