Combined treatment of fourth ventricle ependymomas: report of 26 cases

Spagnoli, D.; Tomei, G.; Ceccarelli, Giovanni; Grimoldi, N.; Lanterna, Luigi Andrea; Bello, Lorenzo; Sinisi, Marco; Santis, A. De; Villani, R.

doi:10.1016/s0090-3019(00)00272-x

Cited by 47 publications

(39 citation statements)

References 33 publications

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“…5,9,18 The prognostic value of histologic findings remains a controversial issue that most likely is attributable to sample size, variability in the definition of anaplasia, discrepancies in histologic diagnoses, and the inclusion in some series of ependymoblastomas and subependymomas, which exhibit different biologic behavior and should be analyzed separately. 1,4,5,9,[19][20][21][22] It is important to emphasize that, in the current study, 57 of 103 patients (55.3%) initially had an incorrect diagnosis of ependymoma. Four classes of pathologic misdiagnoses can be distinguished.…”

Section: Discussionmentioning

confidence: 58%

Supratentorial ependymomas: Prognostic factors and outcome analysis in a retrospective series of 46 adult patients

Métellus

Figarella‐Branger

Guyotat

et al. 2008

Cancer

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BACKGROUND.Ependymomas account for 2% of all intracranial tumors in adults. Supratentorial ependymomas are less common than their infratentorial counterparts. To the authors' knowledge to date, the predictive values of surgery, histology, and patient‐related prognostic factors for these tumors remain unresolved. The authors report a series of adult patients with supratentorial ependymomas to characterize the roles of surgery and histology in tumor control.METHODS.The authors retrospectively studied a homogenous population of 46 adult patients who had supratentorial ependymomas from 24 French neurosurgical centers between 1990 and 2004. All clinicoradiologic and follow‐up data were analyzed, and a central pathologic review was performed by 2 certified neuropathologists.RESULTS.The mean (±standard error) 5‐ and 10‐year overall survival rates for the entire population were 57.1% ± 8.7% and 41.8% ± 9.9%, respectively. The 5‐ and 10‐year progression‐free survival rates for the entire cohort were of 33.8% ± 8.1% and 25.4 ± 8%, respectively. On both univariate and multivariate analysis, age <55 years, greater extent of surgery, and lower histologic grade were associated with longer overall and progression‐free survival. However, longer progression‐free survival but was not considered a candidate variable for the multivariate model, because data were available for only 34 of 46 patients.CONCLUSIONS.In association with age and extent of surgery, histologic grade was identified as a major prognostic factor in adult supratentorial ependymomas. The application of a simple and reproducible grading scheme using objective anaplastic criteria appeared to be both useful practically and clinically applicable. The role of adjuvant radiotherapy for patients with incompletely resected, low‐grade ependymomas needs to be investigated further. Cancer 2008. © 2008 American Cancer Society.

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Section: Discussionmentioning

confidence: 58%

Supratentorial ependymomas: Prognostic factors and outcome analysis in a retrospective series of 46 adult patients

Métellus

Figarella‐Branger

Guyotat

et al. 2008

Cancer

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“…5,9,12,18,19,34 For this analysis, confounding factors included the unreliability of surgical assessment of the degree of ablation 35 and differences in the composition of compared groups with respect to age, performance status, and tumor grade, site, and size. In the current series, as in previous studies, 15,16 no statistically significant difference in overall survival was observed on univariate or multivariate analysis.…”

Section: Prognostic Factorsmentioning

confidence: 99%

A multicenter study of the prognosis and treatment of adult brain ependymal tumors

Reni

Brandes

Vavassori

et al. 2004

Cancer

105

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BACKGROUNDThe current analysis of outcomes in a large series of adult patients with intracranial ependymal tumors contributes to the characterization of the primary prognostic factors and to the therapeutic management of this rare disease, for which limited information is available in the literature.METHODSThe authors analyzed data on patient and tumor characteristics, treatment, and survival in a series of 70 patients age > 17 years with pathologic diagnoses of brain ependymal tumors from 4 institutions.RESULTSThe 5‐ and 10‐year overall survival (OS) rates (± standard errors) were 67% ± 6% and 50% ± 8%, respectively. The 5‐ and 10‐year failure‐free survival (FFS) rates were 43% ± 7% and 24% ± 6%, respectively. Younger age and infratentorial tumor location were associated with longer survival. Among patients with Grade 2 ependymoma (n = 51), 21 (41%) received no postsurgical treatment. These 21 patients had a 5‐year OS rate of 78% ± 10% and a 10‐year OS rate of 68% ± 13%; the 5‐ and 10‐year FFS rates for these patients were 47% ± 12% and 12% ± 11%, respectively. Twenty‐six patients with Grade 2 ependymoma (51%) received postoperative radiotherapy (RT). These 26 patients had a 5‐year OS rate of 71% ± 9% and a 10‐year OS rate of 59% ± 11%; the 5‐ and 10‐year FFS rates for these patients were 54% ± 10% and 34% ± 10%, respectively. Among patients with Grade 2 ependymoma, neither OS nor FFS differed significantly between those who did not receive postoperative RT and those who did; however, these two groups were heterogeneous with respect to prognostic factors. On multivariate analysis, RT use exhibited a trend toward improved OS and was significantly predictive of improved FFS.CONCLUSIONSThe current analysis does not rule out the possibility that deferral of RT at the time of recurrence could have a detrimental effect on FFS or OS in patients with Grade 2 ependymoma, regardless of the degree of ablation. The role of postoperative RT for patients who undergo imaging‐based macroscopic total resection remains to be addressed. Cancer 2004. © 2004 American Cancer Society.

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“…4,21,22) All 4 patients with geriatric fourth ventricle ependymoma underwent surgical resection: gross total resection was achieved in 1 case, subtotal resection in 2 cases, and unknown in the other case. The difference in 5-year survival rate between tumor grades of posterior fossa ependymoma was not statistically significant, 21,27) and, in general, the degree of resection correlated with better prognosis. 13,17,27) Nevertheless, gross total resection may be difficult for ependymomas arising from the caudal half or the lateral part of the fourth ventricle, because critical anatomical structures are present around the tumor.…”

Section: Discussionmentioning

confidence: 71%

“…The difference in 5-year survival rate between tumor grades of posterior fossa ependymoma was not statistically significant, 21,27) and, in general, the degree of resection correlated with better prognosis. 13,17,27) Nevertheless, gross total resection may be difficult for ependymomas arising from the caudal half or the lateral part of the fourth ventricle, because critical anatomical structures are present around the tumor. 13) Although the tumor origins of the 3 above cases are unknown, subtotal resection may be accepted in the elderly population to avoid postoperative complications.…”

Section: Discussionmentioning

confidence: 71%

“…Several studies indicated that the survival period for children with ependymoma was shorter than that for adults, since ependymomas in children originate from more immature and more aggressive cells. 7,21,27) Thus, the survival period of geriatric ependymoma may be longer than that for younger patients, so stereotactic radiotherapy for residual tumor in the fourth ventricle may be an option after subtotal resection. 16,17,19) Although there have been several chemotherapy regimens for ependymoma, none has been established.…”

Section: Discussionmentioning

confidence: 99%

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Clinical, Histological, and Genetic Features of Fourth Ventricle Ependymoma in the Elderly

Hayashi

Inamasu

Kanai

et al. 2012

Neurol. Med. Chir.(Tokyo)

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A 71-year-old woman presented with a rare case of geriatric ependymoma originating from the fourth ventricle manifesting as progressive gait and memory disturbance. Imaging studies revealed an extraaxial mass in the fourth ventricle protruding into the right cerebellomedullary cistern, with concomitant obstructive hydrocephalus. Surgery achieved subtotal removal since the tumor tightly adhered to the right vestibular area of the fourth ventricular floor. The histological diagnosis was ependymoma, which was also confirmed by comparative genetic hybridization. Although she developed severe laryngeal edema and worsening of the hydrocephalus postoperatively which required additional treatment, she recovered with residual mild gait disturbance, and was transferred to a rehabilitation facility. Fourth ventricle ependymoma in the elderly is rare. Comparative genetic hybridization may be important in the diagnosis of geriatric ependymoma and in the choice for adjuvant therapy as well as in estimating the prognosis for patients with rare types of ependymoma.

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Combined treatment of fourth ventricle ependymomas: report of 26 cases

Cited by 47 publications

References 33 publications

Supratentorial ependymomas: Prognostic factors and outcome analysis in a retrospective series of 46 adult patients

Supratentorial ependymomas: Prognostic factors and outcome analysis in a retrospective series of 46 adult patients

A multicenter study of the prognosis and treatment of adult brain ependymal tumors

Clinical, Histological, and Genetic Features of Fourth Ventricle Ependymoma in the Elderly

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