• Stergios Zacharoulis, Adam Levy, Susan N Chi, Sharon Gardner, Marc Rosenblum, Douglas C Miller, Ira Dunkel, Blanca Diez, Richard Sposto, Lingyun Ji, Shahab Asgharzadeh, Juliette Hukin, Jean Belasco, Ronald Dubowy, Stewart Kellie, Amanda Termuhlen, and Jonathan Finlay.
• Department of Pediatric Hematology/Oncology, Children's Hospital Los Angdes, Neural Tumors Program, Los Angles, CA 900 27, USA. szacharoulis@chla.usc.edu
• Pediatr Blood Cancer. 2007 Jul 1; 49 (1): 34-40.

BackgroundThe purpose of this study is to investigate the efficacy of an intensive chemotherapy induction regimen followed by myeloablative chemotherapy and autologous hematopoietic stem cell rescue (AHSCR) in children with newly diagnosed ependymoma.Patients And MethodsTwenty-nine children less than 10 years of age at diagnosis of ependymoma were enrolled on the "Head Start" studies. Twenty-four patients with localized disease received an induction regimen including five cycles of chemotherapy (cisplatin, vincristine, etoposide cyclophosphamide, and high dose methotrexate for patients with metastatic disease). Following induction, individuals without evidence of disease proceeded to marrow-ablative chemotherapy (thiotepa, carboplatin, and etoposide) with AHSCR.ResultsThe estimated 5-year event free survival (EFS) and overall survival (OS) from diagnosis were 12% (+/-6%) and 38% (+/-10%), respectively. The toxic mortality amongst this group of 29 patients was 10.3%. Younger age (less than 18 months at diagnosis) was the only statistically significant prognostic factor. The estimated 5-year OS rate for the five patients with metastatic disease at presentation was 80% (+/-18%). Overall, radiation-free survival at 5 years from diagnosis was 8% (+/-5%).ConclusionsThe use of an intensive induction chemotherapy regimen including myeloablative chemotherapy followed by AHSCR in newly diagnosed young children with ependymoma is not superior to other previously reported chemotherapeutic strategies.

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