Molecular grouping and outcomes of young children with newly diagnosed ependymoma treated on the multi-institutional SJYC07 trial

Santhosh A. Upadhyaya, Giles W. Robinson, Arzu Onar-Thomas, Brent A. Orr, Catherine A. Billups, Daniel C. Bowers, Anne E. Bendel, Tim Hassall, John R. Crawford, Sonia Partap, Paul G. Fisher, Ruth G. Tatevossian, Tiffany Seah, Ibrahim A. Qaddoumi, Anna Vinitsky, Gregory T. Armstrong, Noah D. Sabin, Christopher L. Tinkle, Paul Klimo, Danny J. IndelicatoFrederick A. Boop, Thomas E. Merchant, David W. Ellison, Amar Gajjar

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10 Scopus citations

Abstract

Background. This report documents the clinical characteristics, molecular grouping, and outcome of young children with ependymoma treated prospectively on a clinical trial. Methods. Fifty-four children (aged ≤3 y) with newly diagnosed ependymoma were treated on the St Jude Young Children 07 (SJYC07) trial with maximal safe surgical resection, 4 cycles of systemic chemotherapy, consolidation therapy using focal conformal radiation therapy (RT) (5-mm clinical target volume), and 6 months of oral maintenance chemotherapy. Molecular groups were determined by tumor DNA methylation using Infinium Methylation EPIC BeadChip and profiled on the German Cancer Research Center/Molecular Neuropathology 2.0 classifier. Results. One of the 54 study patients had metastases (cerebrospinal fluid positive) at diagnosis. Gross or neartotal resection was achieved in 48 (89%) patients prior to RT. At a median follow-up of 4.4 years (range, 0.2-10.3 y), 4-year progression-free survival (PFS) was 75.1% ±7.2%, and overall survival was 92.6% ±4.4%. The molecular groups showed no significant difference in PFS (4-year estimates: Posterior fossa ependymoma group A [PF-EPN-A; 42/54], 71.2% ±8.3%; supratentorial ependymoma positive for v-rel avian reticuloendotheliosis viral oncogene homolog A [ST-EPN-RELA; 8/54], 83.3% ±17.0%; and supratentorial ependymoma positive for Yes-associated protein [4/54], 100%, P = 0.22). Subtotal resection prior to RT was associated with an inferior PFS compared with gross or near-total resection (4-year PFS: 41.7% ±22.5% vs 79.0% ±7.1%, P = 0.024), as was PF-EPN-A group with 1q gain (P = 0.05). Histopathologic grading was not associated with outcomes (classic vs anaplastic; P = 0.89). Conclusions. In this prospectively treated cohort of young children with ependymoma, ST-EPN-RELA tumors had a more favorable outcome than reported from retrospective data. Histologic grade did not impact outcome. PF-EPN-A with 1q gain and subtotal resection were associated with inferior outcomes.

Original languageEnglish (US)
Pages (from-to)1319-1330
Number of pages12
JournalNeuro-oncology
Volume21
Issue number10
DOIs
StatePublished - 2019

Keywords

  • 1q gain
  • Chemotherapy
  • Clinical target volume
  • Ependymoma groups

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology
  • Cancer Research

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    Upadhyaya, S. A., Robinson, G. W., Onar-Thomas, A., Orr, B. A., Billups, C. A., Bowers, D. C., Bendel, A. E., Hassall, T., Crawford, J. R., Partap, S., Fisher, P. G., Tatevossian, R. G., Seah, T., Qaddoumi, I. A., Vinitsky, A., Armstrong, G. T., Sabin, N. D., Tinkle, C. L., Klimo, P., ... Gajjar, A. (2019). Molecular grouping and outcomes of young children with newly diagnosed ependymoma treated on the multi-institutional SJYC07 trial. Neuro-oncology, 21(10), 1319-1330. https://doi.org/10.1093/neuonc/noz069