Participants exhibit an initial pattern of failure that is local (disease confined to primary site). Treatment is surgery and a second course of focal irradiation. The total dose for the second course of irradiation will be 54Gy.
Participants may receive one or both: Photon therapy or proton therapy.
Participants receive ^1^8F-fluorodeoxyglucose and ^1^1C-methionine to aid in tumor visualization.

Participants exhibit an initial pattern of failure that is metastatic (neuraxis metastatic disease without equivocal evidence of local failure). Treatment is surgery and craniospinal irradiation. Craniospinal irradiation (36-39.6Gy) will include focal boost treatment of metastatic sites (54-59.4Gy) depending on location, extent of resection and target volume.
Participants may receive one or both: Photon therapy or proton therapy.
Participants receive ^1^8F-fluorodeoxyglucose and ^1^1C-methionine to aid in tumor visualization.

Participants exhibit an initial pattern of failure that is both local and metastatic (neuraxis metastatic disease with equivocal evidence of local failure). Treatment is surgery and craniospinal irradiation.
Participants may receive one or both: Photon therapy or proton therapy.
Participants receive ^1^8F-fluorodeoxyglucose and ^1^1C-methionine to aid in tumor visualization.

Local Failure Participants exhibit an initial pattern of failure that is local (disease confined to primary site). Age is >36 months at time of enrollment to <21 years. Tumor shows presence of 1q gain. Treatment is optional craniospinal irradiation.
Participants may receive one or both: Photon therapy or proton therapy.
Participants receive ^1^8F-fluorodeoxyglucose and ^1^1C-methionine to aid in tumor visualization.

Ependymoma

Radiation therapy on this protocol will be based on extent of disease, extent of resection and location. The allowed treatment modalities include conformal or intensity-modulated radiation therapy using photons or proton therapy using double-scattering or spot-scanning methods. The general goal is to initiate radiation therapy within 12 weeks of last surgery performed at the time of recurrence.

Irradiation

When applicable, surgery will be used to remove metastases. The goal of surgery is to achieve gross total resection of all imaging visible residual tumor.

Surgery

This is a contrast media that will be given intravenously to aid in tumor visualization.

^1^8F-Fluorodeoxyglucose

^1^1C-methionine

Participants will receive one or both: Photon or proton therapy.

Photon therapy

Proton therapy

St. Jude Children's Research Hospital

Princess Margaret Cancer Centre

A Trial of Surgery and Fractionated Re-Irradiation for Recurrent Ependymoma

A Phase II Trial of Surgery and Fractionated Re-Irradiation for Recurrent Ependymoma

Evaluation will be in children and young adults with ependymoma treated with a second course of irradiation.
Outcomes will be reported by p-values.

Evaluation will be in children and young adults with ependymoma treated with a second course of irradiation.
Outcome will be reported with p values.

Evaluation will be in children and young adults with ependymoma treated with a second course of irradiation.
Outcome will be reported with p-values.

Baseline is defined as day 1 of radiation therapy.

Baseline is defined as day 1 of radiation therapy.
Measured task sets: BOT2 (4-21 years old) and PPT (≥22 years old).
BOT2 outcome: total motor composite, a standardized score range from 20 to 80, with a mean of 50 and a standard deviation of 10.
PPT (7-item questionnaire) outcome: a score range from 0 to 28. The normative data is available from the human performance lab.
The above scores will be standardized into z-scores/T-scores for data analysis based on normative data.

Baseline is defined as day 1 of radiation therapy.
Self-reported instruments (PROMIS): Three questionnaires.
Pediatric Physical Function - Mobility - SF1: 8-item questionnaire with the score range from 0 to 32.
Pediatric Physical Function - Upper Extremity - SF1: same as above.
Physical Function - SF1: 10-item questionnaire with the score range from 0 to 50.
The above scores will be standardized into z-scores/T-scores for data analysis based on normative data

Baseline is defined as day 1 of radiation therapy

Baseline is defined as day 1 of radiation therapy.
Ankle dorsiflexion active and passive range of motion: measured by goniometer, and recorded as an angle (degree).

Baseline is defined as day 1 of radiation therapy.
Overall flexibility: measured by sit and reach test, and recorded as a length (cm).

Baseline is defined as day 1 of radiation therapy.
Balance measured by Measured by sensory organization test (SOT), and the result from the test is the equilibrium score, a percentage range from 0% to 100%, with the higher percentage, the better balance. The outcome is a binary variable with a cutoff score of < 70% indicates future risk for a fall.

Baseline is defined as day 1 of radiation therapy.
Fine motor coordination (finger and hand coordination). Measured by Composite Cerebellar Functional Severity Score (CCFS), and the outcome is an age-adjusted z-score and log transformed.

Baseline is defined as day 1 of radiation therapy.
Overall coordination measured by brief ataxia rating scale (five-item questionnaire). The outcome is a total scale range from 0 to 22.

Baseline is defined as day 1 of radiation therapy.
Lower extremity strength measured by BiodexIII. The outcomes are peak torque value/body weight ratios at different speeds of motion.
The scores will be standardized into z-scores for data analysis based on normative data.

Baseline is defined as day 1 of radiation therapy.
Hand grip strength is measured by a Jamar hand held dynamometer and recorded in kilograms (kg).
The scores will be standardized into z-scores for data analysis based on normative data.

Baseline is defined as day 1 of radiation therapy.
Resting energy expenditure is measured with indirect calorimetry after an overnight fast and recorded as REE (kcal/day).
The scores will be standardized into z-scores for data analysis based on normative data.

Baseline is defined as day 1 of radiation therapy.
Cardiopulmonary exercise test (CPET) will be completed on a treadmill using the Balke protocol or cycle ergometer using an incremental ramping protocol. The outcome is recorded as VO2max (ml/kg/min).
The scores will be standardized into z-scores for data analysis based on normative data.

Baseline is defined as the last MRI prior to initiation of radiation therapy.

This outcome will be evaluated by neuroimaging. Baseline is defined as day 1 of radiation therapy.

Baseline is the last FDG-PET and MET-PET prior to initiation of radiation therapy.

Correlation of avidity of ependymoma to 18F-fluorodeoxyglucose and 11C-methionine PET prior to radiation therapy with progression-free survival will be reported

Association between necrosis measured with MET/FDG vs. MRI Baseline is defined as day 1 of radiation therapy (RT).

Evaluate will be of genetic variations in germline associated with treatment response and side effects. P-values will be reported.
Baseline is defined as day 1 of radiation therapy.

ependymoma/fatigue

A Trial of Surgery and Fractionated Re-Irradiation for Recurrent Ependymoma

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