{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T16:54:11Z","timestamp":1791478451866,"version":"4.3.4"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2024,8,22]],"date-time":"2024-08-22T00:00:00Z","timestamp":1724284800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","award":["SCHU2442\/8-1"],"award-info":[{"award-number":["SCHU2442\/8-1"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Collaborative Ependymoma Research Network"},{"name":"German Children Cancer Foundation","award":["DKS 2006.01"],"award-info":[{"award-number":["DKS 2006.01"]}]},{"name":"German Children Cancer Foundation","award":["DKS 2008.07"],"award-info":[{"award-number":["DKS 2008.07"]}]},{"name":"German Children Cancer Foundation","award":["DKS 2012.03"],"award-info":[{"award-number":["DKS 2012.03"]}]},{"name":"German Children Cancer Foundation","award":["DKS 2015.02"],"award-info":[{"award-number":["DKS 2015.02"]}]},{"name":"German Children Cancer Foundation","award":["DKS 2017.12"],"award-info":[{"award-number":["DKS 2017.12"]}]},{"name":"German Children Cancer Foundation","award":["DKS 2020.02"],"award-info":[{"award-number":["DKS 2020.02"]}]},{"name":"Neuroradiology and Neuropathology of the German"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Ependymoma (EPN) is not a uniform disease but represents different disease types with biological and clinical heterogeneity. However, the pattern of when and where different types of EPN relapse is not yet comprehensively described.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We assembled 269 relapsed intracranial EPN from pediatric (n\u2005=\u2005233) and adult (n\u2005=\u200536) patients from European and Northern American cohorts and correlated DNA methylation patterns and copy-number alterations with clinical information.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The cohort comprised the following molecular EPN types: PF-EPN-A (n\u2005=\u2005177), ST-EPN-ZFTA (n\u2005=\u200545), PF-EPN-B (n\u2005=\u200531), PF-EPN-SE (n\u2005=\u200512), and ST-EPN-YAP (n\u2005=\u20054). First relapses of PF-EPN-B (PF: posterior-fossa) and PF-EPN-SE (SE: subependymoma) occurred later than of PF-EPN-A, ST-EPN-YAP (ST: supratentorial), or ST-EPN-ZFTA (median time to relapse: 4.3 and 6.0 years vs. 1.9\/1.0\/2.4 years; P\u2005&amp;lt;\u2005.01). Metastatic or combined recurrences in PF-EPN-B and -A more often involved the spinal cord than in ST-EPN-ZFTA (72.7% and 40.0 vs. 12.5%; P\u2005&amp;lt;\u2005.01). No distant relapses were observed in ST-EPN-YAP (n\u2005=\u20054) or PF-EPN-SE (n\u2005=\u200512). Post-relapse survival (PRS) was poor for PF-EPN-A and ST-EPN-ZFTA (5-year PRS: 44.5%\u2005\u00b1\u20054.4%\/47.8%\u2005\u00b1\u20059.1%), whereas PF-EPN-B and PF-EPN-SE displayed a 5-year PRS of 89.5%\u2005\u00b1\u20057.1%\/90.0%\u2005\u00b1\u20059.5% (P\u2005=\u2005.03). However, 10-year PRS for PF-EPN-B dropped to 45.8%\u2005\u00b1\u200517.3%. Neither between the radiation field and relapse pattern nor between the radiation field and spinal involvement at relapse an impact was identified. Notably, all patients with relapsed ST-EPN-YAP did not receive upfront radiotherapy but were successfully salvaged using irradiation at relapse.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Relapse patterns of specific EPN types are different. Future clinical trials, treatment adaptions, duration of surveillance, and diagnostics should be planned to incorporate entity-specific relapse information.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/neuonc\/noae166","type":"journal-article","created":{"date-parts":[[2024,8,20]],"date-time":"2024-08-20T16:58:28Z","timestamp":1724173108000},"page":"267-276","source":"Crossref","is-referenced-by-count":9,"title":["Distinct relapse pattern across molecular ependymoma types"],"prefix":"10.1093","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3216-8452","authenticated-orcid":false,"given":"Denise","family":"Obrecht-Sturm","sequence":"first","affiliation":[{"name":"Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Schoof","sequence":"additional","affiliation":[{"name":"Research Institute Children\u2019s Cancer Center Hamburg , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicia","family":"Eckhardt","sequence":"additional","affiliation":[{"name":"Institute of Neuropathology, University Medical Center Hamburg-Eppendorf , Hamburg ,","place":["Germany"]},{"name":"Research Institute Children\u2019s Cancer Center Hamburg , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3302-2719","authenticated-orcid":false,"given":"Martin","family":"Mynarek","sequence":"additional","affiliation":[{"name":"Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg-Eppendorf , Hamburg ,","place":["Germany"]},{"name":"Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2556-9722","authenticated-orcid":false,"given":"Mark R","family":"Gilbert","sequence":"additional","affiliation":[{"name":"Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health , Bethesda, Maryland ,\u00a0","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Aldape","sequence":"additional","affiliation":[{"name":"Laboratory of Pathology, National Cancer Institute , Bethesda, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terri S","family":"Armstrong","sequence":"additional","affiliation":[{"name":"Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health , Bethesda, Maryland ,\u00a0","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6557-895X","authenticated-orcid":false,"given":"Vijay","family":"Ramaswamy","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology, The Hospital for Sick Children , Toronto, Ontario ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Bockmayr","sequence":"additional","affiliation":[{"name":"Institute of Pathology, Charit\u00e9 University Medicine , Berlin ,","place":["Germany"]},{"name":"Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katja","family":"von Hoff","sequence":"additional","affiliation":[{"name":"Aarhus University Hospital Department of Pediatrics and Adolescent Medicine, , Aarhus ,","place":["Denmark"]},{"name":"Charit\u00e9 University Medicine Department of Pediatric Oncology and Hematology, , Berlin ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gudrun","family":"Fleischhack","sequence":"additional","affiliation":[{"name":"Pediatrics III, Center for Translational Neuro- and Behavioral Sciences (CTNBS), University Hospital of Essen , Essen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas E","family":"Adolph","sequence":"additional","affiliation":[{"name":"Pediatrics III, Center for Translational Neuro- and Behavioral Sciences (CTNBS), University Hospital of Essen , Essen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Tippelt","sequence":"additional","affiliation":[{"name":"Pediatrics III, Center for Translational Neuro- and Behavioral Sciences (CTNBS), University Hospital of Essen , Essen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5447-5322","authenticated-orcid":false,"given":"Stefan M","family":"Pfister","sequence":"additional","affiliation":[{"name":"Division of Pediatric Glioma Research, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK) , Heidelberg ,","place":["Germany"]},{"name":"Hopp Children\u2019s Cancer Center Heidelberg (KiTZ) , Heidelberg ,","place":["Germany"]},{"name":"Heidelberg University Hospital Department of Pediatric Oncology, Hematology and Immunology, , Heidelberg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristian","family":"Pajtler","sequence":"additional","affiliation":[{"name":"Division of Pediatric Glioma Research, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK) , Heidelberg ,","place":["Germany"]},{"name":"Hopp Children\u2019s Cancer Center Heidelberg (KiTZ) , Heidelberg ,","place":["Germany"]},{"name":"Heidelberg University Hospital Department of Pediatric Oncology, Hematology and Immunology, , Heidelberg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominik","family":"Sturm","sequence":"additional","affiliation":[{"name":"Division of Pediatric Glioma Research, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK) , Heidelberg ,","place":["Germany"]},{"name":"Hopp Children\u2019s Cancer Center Heidelberg (KiTZ) , Heidelberg ,","place":["Germany"]},{"name":"Heidelberg University Hospital Department of Pediatric Oncology, Hematology and Immunology, , Heidelberg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4830-3671","authenticated-orcid":false,"given":"Richard","family":"Drexler","sequence":"additional","affiliation":[{"name":"University Medical Center Hamburg-Eppendorf Department for Neurosurgery, , Hamburg ,\u00a0","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franz L","family":"Ricklefs","sequence":"additional","affiliation":[{"name":"University Medical Center Hamburg-Eppendorf Department for Neurosurgery, , Hamburg ,\u00a0","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Stepien","sequence":"additional","affiliation":[{"name":"Comprehensive Center for Pediatrics and Comprehensive Cancer Center, Medical University of Vienna Department of Pediatrics and Adolescent Medicine, , Vienna ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Gojo","sequence":"additional","affiliation":[{"name":"Comprehensive Center for Pediatrics and Comprehensive Cancer Center, Medical University of Vienna Department of Pediatrics and Adolescent Medicine, , Vienna ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Torsten","family":"Pietsch","sequence":"additional","affiliation":[{"name":"University of Bonn Medical Center Department of Neuropathology and DGNN Brain Tumor Reference Center, , Bonn ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3544-319X","authenticated-orcid":false,"given":"Monika","family":"Warmuth-Metz","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Neuroradiology, University Hospital Wuerzburg , W\u00fcrzburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rolf","family":"Kortmann","sequence":"additional","affiliation":[{"name":"University of Leipzig Department of Radiation Oncology, , Leipzig ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beate","family":"Timmermann","sequence":"additional","affiliation":[{"name":"University of Leipzig Department of Radiation Oncology, , Leipzig ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1016-0545","authenticated-orcid":false,"given":"Christine","family":"Haberler","sequence":"additional","affiliation":[{"name":"Division of Neuropathology and Neurochemistry, Medical University of Vienna Department of Neurology, ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Rutkowski","sequence":"additional","affiliation":[{"name":"Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8731-1121","authenticated-orcid":false,"given":"Ulrich","family":"Sch\u00fcller","sequence":"additional","affiliation":[{"name":"Institute of Neuropathology, University Medical Center Hamburg-Eppendorf , Hamburg ,","place":["Germany"]},{"name":"Research Institute Children\u2019s Cancer Center Hamburg , Hamburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,8,22]]},"reference":[{"issue":"4","key":"2025011311115946300_CIT0001","doi-asserted-by":"crossref","first-page":"725","DOI":"10.3171\/2008.9.JNS08117","article-title":"Incidence patterns for ependymoma: A surveillance, epidemiology, and end results study","volume":"110","author":"McGuire","year":"2009","journal-title":"J Neurosurg."},{"issue":"2","key":"2025011311115946300_CIT0002","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1016\/j.jss.2009.04.024","article-title":"Outcomes of malignant CNS ependymomas: An examination of 2408 cases through the Surveillance, Epidemiology, and End Results (SEER) database (1973-2005)","volume":"156","author":"Rodr\u00edguez","year":"2009","journal-title":"J Surg Res."},{"key":"2025011311115946300_CIT0003","volume-title":"Classification of Tumours Editorial Board, WHO 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