Adjuvant radiotherapy in the treatment of pediatric myxopapillary ependymomas

Al-Halabi, H.; Montes, José L.; Atkinson, Jeffrey; Farmer, Jean‐Pierre; Freeman, Carolyn R.

doi:10.1002/pbc.22614

Cited by 51 publications

(55 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Their suggestion of treating pediatric MPE patients with adjuvant radiotherapy is one that the authors of several smaller studies have also proposed based on more anecdotal evidence. 4,16,24 Our review has indicated that STR with radiotherapy in children may be associated with better outcomes than is STR with radiotherapy in adults.…”

Section: Discussionmentioning

confidence: 99%

“…28 A third explanation is that pediatric MPEs are more difficult to diagnose early than are adult MPEs because pediatric patients are unable to communicate their symptoms to physicians. 1,4,24 Further research is needed to understand the observed disparity between pediatric and adult MPEs. Nevertheless, at the current time, it appears that surgeons should attempt GTR whenever possible.…”

Section: Discussionmentioning

confidence: 99%

“…1,6,16,23,[27][28][29]32 In total, 28 articles with 475 patients were included in this integrative analysis. [2][3][4][5][7][8][9][10][11][12][13][14][15][17][18][19][20][21][23][24][25][26]30,31,[34][35][36][37] …”

Section: Article Selectionmentioning

confidence: 99%

See 2 more Smart Citations

Tumor control after surgery for spinal myxopapillary ependymomas: distinct outcomes in adults versus children

Feldman

Clark²,

Safaee³

et al. 2013

SPI

View full text Add to dashboard Cite

Object Myxopapillary ependymomas (MPEs) are rare WHO Grade I tumors found in the conus medullaris, cauda equina, and filum terminale. Treatment generally consists of resection with or without adjuvant radiotherapy. Evidence-based guidelines for surgical management are lacking due to the rarity of this tumor. Methods An English-language PubMed search was performed using the key words “myxopapillary” and “ependymoma.” Reports describing fewer than 3 patients or those lacking data on the extent of resection or radiotherapy were excluded. A total of 28 articles describing 475 patients met the authors' inclusion criteria. Patients were grouped by extent of resection and whether or not they underwent adjuvant radiotherapy. Differences in recurrence rates were assessed by chi-square test. Results The overall recurrence rate was 15.5% in patients treated by gross-total resection (GTR) and 32.6% in patients treated by subtotal resection (STR), irrespective of whether they underwent adjuvant therapy (p < 0.001). Regardless of the extent of resection, adjuvant radiotherapy was not associated with a decrease in recurrence rates. The overall recurrence rate was 15.6% in patients who underwent GTR and radiotherapy compared with 15.9% in patients who underwent GTR alone (p = 0.58), and it was 29.3% in patients who underwent STR and radiotherapy compared with 35.1% in those who underwent STR alone (p = 0.53). The difference between recurrence rates for patients who underwent GTR alone versus STR and radiotherapy was statistically significant (p = 0.02). Subgroup analysis demonstrated significantly higher recurrence rates in pediatric patients compared with adults (40.5% vs 23.4%, respectively; p = 0.02). Even in the setting of GTR alone, recurrence rates were higher in pediatric patients (65% vs 7.6%; p < 0.001). Conclusions Gross-total resection alone is associated with decreased recurrence rates compared with STR with or without radiotherapy. The authors' results suggest that treatment goals should include attempted GTR whenever possible. The observation that children benefitted from radiation therapy to a greater extent than did adults suggests that biological differences between tumors in these patient populations warrants more rigorous scientific studies.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Tumor control after surgery for spinal myxopapillary ependymomas: distinct outcomes in adults versus children

Feldman

Clark²,

Safaee³

et al. 2013

SPI

View full text Add to dashboard Cite

show abstract

“…7,42,62 Maximal resection is generally agreed to be the cornerstone of treatment for pediatric spinal ependymomas; 2,7,8,34,42,47,50 however, the addition of adjuvant radiation therapy after surgery is the subject of more debate. 2,7,8,48 While there are many studies on spinal ependymomas in adults, 11,12,[16][17][18]21,24,25,38,41,45,51,56,57,61,65 there are few papers on these tumors in children, and those that do exist tend to be small, single-institution retrospective studies that are not powered for statistical analysis stratified by tumor grade. 2,8,13,22,27,42,47,53 The goal of this paper is to use the nationally representative Surveillance Epidemiology and End Results (SEER) database to offer a population-based perspective on pediatric Grade II spinal ependymomas.…”

mentioning

confidence: 99%

Treatment of pediatric Grade II spinal ependymomas: a population-based study

Lin

Jea

Melkonian

et al. 2015

PED

View full text Add to dashboard Cite

OBJECT Grade II spinal cord ependymomas occurring in pediatric patients are exceptionally rare neoplasms. In this paper the authors use a national cancer database to determine patient demographics, treatment patterns, and associated outcomes of this cohort. METHODS The Surveillance Epidemiology and End Results (SEER) database was used to analyze subjects younger than 18 years with histologically confirmed diagnoses of Grade II spinal cord ependymoma from the years 1973 to 2008. Descriptive data on the demographic characteristics of this cohort and the associated treatment patterns are shown. The Kaplan-Meier method was used to estimate overall survival at 1, 2, 5, and 10 years. RESULTS This cohort comprised 64 pediatric subjects with Grade II spinal ependymoma. The median age was 13 years, nearly half of the patients were male, and most were white (84%). The median follow-up was 9.2 years. Overall survival at 5 and 10 years was 86% and 83%, respectively. Gross-total resection was achieved in 57% of subjects, and radiation therapy was administered to 36%. Radiation therapy was administered to 78% of subjects after subtotal resection but only to 19% of patients after gross-total resection; this difference was significant (p < 0.001). In a multivariate regression model analyzing sex, age at diagnosis, year of diagnosis, radiotherapy, and extent of resection, female sex was found to be an independent predictor of decreased mortality (HR 0.15 [95% CI 0.02–0.94], p = 0.04). CONCLUSIONS These data show long-term outcomes for pediatric patients with Grade II spinal ependymoma. Radiotherapy was more likely to be administered in cases of subtotal resection than in cases of gross-total resection. Female sex is associated with decreased mortality, while other demographic or treatment modalities are not.

show abstract

“…1,3,4,7,10,12 In a pediatric population of 15 children with MPE from the Johns Hopkins Hospital, the local control rate at 5 and 10 3 Resection and adjuvant radiotherapy were performed in 4 patients; 3 of these patients remained disease-free compared with 2 of 3 patients with GTR alone who experienced disease recurrence. Only 6 pediatric cases were available for analysis in the present series.…”

mentioning

confidence: 99%

Outcomes following myxopapillary ependymoma resection: the importance of capsule integrity

Abdulaziz¹,

Mallory²,

Bydon

et al. 2015

FOC

View full text Add to dashboard Cite

OBJECT While extent of resection has been shown to correlate with outcomes after myxopapillary ependymoma (MPE) resection, the effect of capsular violation has not been well studied. The role of adjuvant radiation also remains controversial. In this paper the authors' goals were to evaluate outcomes following resection of MPE based on intraoperative capsular violation and to explore the role of adjuvant radiotherapy in cases of capsular violation. METHODS A retrospective review of patients undergoing resection of MPE at 2 academic institutions between 1990 and 2013 was performed. Cases with dissemination at presentation, less than 12 months of follow-up, or incomplete records were excluded. Extent of resection was defined as en bloc if all visible tumor was removed without capsular violation, gross-total resection (GTR) if all visible tumor was removed, but with capsular violation, and subtotal resection (STR) if a known residual was left at the time of surgery. Postoperative MR images were reviewed to confirm the extent of resection. Primary outcomes were progression-free survival (PFS) and overall recurrence rates. The effects of extent of resection, capsular violation, and adjuvant radiotherapy on recurrence rates and PFS were analyzed using Kaplan-Meier statistics. Associations between recurrence and preoperative variables were evaluated using Fisher exact methods and t-tests where appropriate. RESULTS Of the 107 patients reviewed, 58 patients (53% were male) met inclusion criteria. The mean age at surgery was 40.8 years (range 7–68 years). The median follow-up was 51.5 months (range 12–243 months). Extent of resection was defined as en bloc in 46.5% (n = 27), GTR in 34.5% (n = 20), and STR in 18.9% (n = 11). No recurrences were noted in the en bloc group, compared with 15% (n = 3) and 45% (n = 5) in the GTR and STR groups. En bloc resection was achieved most frequently in tumors involving the conus. Twelve patients (20%) underwent adjuvant radiotherapy following either STR or GTR. The overall recurrence rate was 13.8% (n = 8), and the 5-year PFS was 81%. Capsular violation was associated with a higher recurrence rate (p = 0.005). Adjuvant radiotherapy showed a nonsignificant trend of lower recurrence rates (16.7% vs 31.6%, p = 0.43) and longer PFS at 5 years (83.3% vs 49.9%, p = 0.16) in cases of capsular violation. CONCLUSIONS A strong correlation between capsular violation and recurrence was found following removal of MPE and should be assessed when defining extent of resection in future studies. Although the use of adjuvant radiotherapy in cases of capsular violation showed a trend toward improved PFS, further investigation is needed to establish its role as salvage therapy also appears to be effective at halting disease progression.

show abstract

Adjuvant radiotherapy in the treatment of pediatric myxopapillary ependymomas

Abstract: Our data support the evolving literature which suggests that GTR alone provides suboptimal disease control in MPE. In our patients, RT resulted in control of residual, metastatic and/or recurrent disease. Routine adjuvant RT may improve outcomes in pediatric MPE.

Cited by 51 publications

References 22 publications

Tumor control after surgery for spinal myxopapillary ependymomas: distinct outcomes in adults versus children

Tumor control after surgery for spinal myxopapillary ependymomas: distinct outcomes in adults versus children

Treatment of pediatric Grade II spinal ependymomas: a population-based study

Outcomes following myxopapillary ependymoma resection: the importance of capsule integrity

Contact Info

Product

Resources

About