A systematic review and meta-analysis of outcomes in pediatric, recurrent ependymoma

  • Lennox Byer
  • Cassie N. Kline
  • Christina Coleman
  • Isabel E. Allen
  • Evans Whitaker
  • Sabine MuellerEmail author
Topic Review



The purpose of this study was to determine outcomes in recurrent pediatric ependymoma.


We performed a systematic review of PubMed, Embase, Web of Science and the Cochrane Library for studies reporting on survival outcomes for pediatric patients with recurrent ependymoma. We then performed a meta-analysis of all eligible results. Survival outcomes were identified across location of recurrence, therapy at recurrence, and age at recurrence.


Eleven studies met final inclusion criteria. Pooled median progression free survival (PFS) from date of first recurrence was 6.7 months (95% confidence interval [95% CI] 4.7–8.8). Pooled median overall survival (OS) from date of first recurrence was 11.2 months (95% CI 6.4–16.0). Participants with supratentorial recurrences demonstrated a shorter OS of 8.3 months (95% CI 3.2–13.3) compared to 20.1 months (95% CI 8.4–31.7) for those with infratentorial recurrence. Patients who underwent surgery at recurrence had a median OS of 24.2 months (95% CI 14.2–34.1) compared to 29.2 months (95% CI 17.4–41.1) in those who received radiation compared to 19.3 months (95% CI 10.3–28.3) in those who received chemotherapy. Patients younger than age 3 years at time of recurrence demonstrated a median OS of 31.0 months (95% CI − 25.3–87.3) compared to 17.5 months (95% CI 9.9–25.2) for those that recurred beyond 3 years of age.


Our findings illustrate that children with recurrent ependymoma suffer from poor outcomes; however, these outcomes range widely depending on patient, tumor, and treatment characteristics. New therapies and treatment strategies are needed to improve outcomes in this group.


Pediatric Recurrent Ependymoma Systematic review 



LB is in part supported by grants from the National Center for Advancing Translational Sciences of the National Institutes of health (TL1TR001871). CK is supported by grants from the Frank A. Campini Foundation, Cannonball Kids’ Cancer (A129749), and National Institutes of Health National Center for Advancing Translational Sciences (KL2TR001870). This content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.


No external funding was used to directly support this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All information gathering and analyses were in accordance with the ethical standards of the UCSF IRB. Accordingly, this study did not require IRB approval given its usage of only unidentifiable information from the literature.

Supplementary material

11060_2019_3255_MOESM1_ESM.docx (27 kb)
Supplementary file1 (DOCX 26 kb)
11060_2019_3255_MOESM2_ESM.pptx (86 kb)
Supplementary file2 (PPTX 85 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.School of MedicineUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Division of Hematology/Oncology, Department of PediatricsUniversity of California, San FranciscoSan FranciscoUSA
  3. 3.Department of NeurologyUniversity of California, San FranciscoSan FranciscoUSA
  4. 4.Department of Pediatrics, Division of Pediatric Hematology/OncologyUCSF Benioff Children’s Hospital, OaklandOaklandUSA
  5. 5.Department of Epidemiology & BiostatisticsUniversity of California, San FranciscoSan FranciscoUSA
  6. 6.UCSF Health Sciences LibraryUniversity of California, San FranciscoSan FranciscoUSA
  7. 7.Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoUSA
  8. 8.University Children’s Hospital ZuerichZurichSwitzerland

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