Ependymoma: Results, Prognostic Factors and Treatment Recommendations

McLaughlin, Margaret; Marcus, Robert B.; Buatti, John M.; McCollough, W. Mark; Mickle, J. Parker; Kedar, Amos; Maria, Bernard L.; Million, Rodney R.

doi:10.1016/s0360-3016(97)00893-6

Cited by 158 publications

(102 citation statements)

References 19 publications

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“…Because the inability to eradicate the primary tumor in both low-grade and high-grade ependymomas remains the single most important factor related to treatment failure, 19 and because no major difference in survival was detectable between patients who received whole-brain irradiation and those who had RT administered to more limited volumes, it appears to be reasonable to use modern conformal techniques to deliver RT to the presurgical tumor bed along with an added margin of 1-2 cm for both lowgrade 5,18,19,21 and high-grade lesions. 4,18,19,29 The role of therapeutic or prophylactic craniospinal irradiation cannot be addressed by the current series, as spinal puncture at diagnosis and at recurrence was not routinely performed, and only a limited number of patients received craniospinal irradiation. Little is also known about the optimal radiation dose to be administered, and patients in the current series were treated in a relatively uniform manner; thus, meaningful conclusions regarding dosing could not be drawn.…”

Section: Treatmentmentioning

confidence: 94%

“…Anaplastic ependymoma is even less common in the adult population, accounting for approximately 20% of all ependymal tumors in the current series; this figure is consistent with previously reported rates of 17-28%. 4,9,16,27,28 Due to the limited sample size, solid conclusions regarding survival differences between patients with Grade 2 ependymal tumors and those with Grade 3 ependymal tumors could not be made. In other series, histology was not assessed 16 or was found to be a significant independent predictor of survival only on univariate analysis, 15 which prevented any firm conclusions from being made, due to differences between compared groups in terms of the distribution of prognostic factors.…”

Section: Prognostic Factorsmentioning

confidence: 99%

“…Supratentorial ependymomas appear to be associated with less favorable prognosis because they are more likely to exhibit peripheral infiltrative growth into the brain parenchyma and because they are less likely to be entirely encapsulated, rendering surgical resection troublesome. 4,5,9,11,15,30 Furthermore, supratentorial tumors exhibit higher mitotic activity than do infratentorial tumors. 31 Among patient-related factors, age Ͼ 40 years had a negative impact on survival.…”

Section: Prognostic Factorsmentioning

confidence: 99%

“…3 Ependymal tumors commonly are infratentorial, particularly in the fourth ventricle. 4,5 Supratentorial ependymomas arise more frequently in the lateral ventricles than in the third ventricle. Subependymomas typically are located in the fourth ventricle or in the lateral ventricles.…”

mentioning

confidence: 99%

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

Reni

Brandes

Vavassori

et al. 2004

Cancer

103

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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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Section: Treatmentmentioning

confidence: 94%

Section: Prognostic Factorsmentioning

confidence: 99%

Section: Prognostic Factorsmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

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

Reni

Brandes

Vavassori

et al. 2004

Cancer

103

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“…Given the relatively indolent nature of many of these tumors, in cases where there are poorly defined planes between the lesion and the spinal cord, safe surgical decision-making should be the rule. Although there is a role for radiotherapy, particularly in more histologically aggressive tumors, [15][16][17] the natural history of the majority of these lesions is generally benign, and thus radiation is clearly not a first or even secondary line of treatment. Its associated side effects, including neurologic worsening from tissue edema or radiation necrosis and the potential wound healing complications after initial and subsequent microsurgical resections, cannot be ignored.…”

Section: Surgical Strategymentioning

confidence: 99%

Contemporary management of adult intramedullary spinal tumors—pathology and neurological outcomes related to surgical resection

et al. 2008

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Study Design: Retrospective chart review and review of the recent literature. Objectives: To present our experience, over an 8-year period, with aggressive microsurgical resection of intramedullary spinal tumors in adults focusing on histology, microsurgical techniques, short-term neurological outcomes, complication avoidance and dorsal column dysfunction (DCD). Results: Histologic analysis revealed a predominance of ependymomas (50%) with astrocytomas only comprising 12.5% of the tumors. We found no significant difference in pre-and postoperative McCormick grades. Although patients did not manifest significant motor weakness postoperatively as a result of surgery, 43.6% of patients exhibited the signs and symptoms of DCD, resulting in significant postoperative morbidity. Conclusion: We present a contemporary adult series of intramedullary spinal tumors. The most significant postoperative morbidity experienced by patients was DCD. The neurosurgeon should recognize the impact of these symptoms, prepare the patient and his/her family for the possibility of DCD, and minimize dorsal column manipulation in an attempt to decrease its prevalence.

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