Intracranial ependymoma: Long-term results of a policy of surgery and radiotherapy

Vanuytsel, L.; Bessell, E.M.; Ashley, S.; Bloom, H. J. G.; Brada, Michael

doi:10.1016/0360-3016(92)90747-6

Cited by 142 publications

(104 citation statements)

References 23 publications

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“…9,10,15,16,18,19 The findings in the current study (5-year OS, 67%; 10-year OS, 50%) were similar. Results also were comparable with respect to 5-and 10-year FFS rates, which were 43% and 24%, respectively, in the current series and 42-55% and 27-43%, respectively, in the literature.…”

Section: Prognostic Factorssupporting

confidence: 77%

“…In the series investigated by Guyotat et al, 15 older patients had a higher rate of infratentorial tumors, Grade 2 histology, and macroscopic total resection compared with younger patients; these characteristics confounded the impact of age on survival. In another series, female gender was found to be associated with increased survival 19 ; in the current series, survival curves for men and women overlapped.…”

Section: Prognostic Factorssupporting

confidence: 40%

“…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%

“…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: 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: Prognostic Factorssupporting

confidence: 77%

Section: Prognostic Factorssupporting

confidence: 40%

Section: Prognostic Factorsmentioning

confidence: 99%

Section: Treatmentmentioning

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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“…Various factors have been reported to influence prognosis, though clinical research in this area has produced many conflicting results. However, gross surgical resection and the use of radiotherapy have been consistently associated with enhanced event-free and overall survival (Nazar et al, 1990;Sutton et al, 1990;Healey et al, 1991;Vanuytsel et al, 1992;Ferrante et al, 1994;Pollack et al, 1995;Bouffet et al, 1998;Robertson et al, 1998;Horn et al, 1999;Grill et al, 2001). Histological features of anaplasia, such as mitoses, microvascular proliferation and necrosis, serve as indicators of biological behaviour in other gliomas, including diffuse astrocytic tumours and oligodendrogliomas (Cohadon et al, 1985;Burger and Green, 1987;Ellison, 1998).…”

mentioning

confidence: 99%

Genetic abnormalities detected in ependymomas by comparative genomic hybridisation

et al. 2002

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Using comparative genomic hybridisation, we have analysed genetic imbalance in a series of 86 ependymomas from children and adults. Tumours were derived from intracranial and spinal sites, and classified histologically as classic, anaplastic or myxopapillary. Ependymomas showing a balanced profile were significantly (P50.0005) more frequent in children than adults. Profiles suggesting intermediate ploidy were common (44% of all tumours), and found more often (P50.0005) in tumours from adults and the spinal region. Loss of 22q was the most common specific abnormality, occurring in 50% of spinal (medullary) ependymomas and 26% of tumours overall. Genetic profiles combining loss of 22q with other specific abnormalities -gain of 1q, loss of 6q, loss of 10q/10, loss of 13, loss of 14q/14 -varied according to site and histology. In particular, we showed that classic ependymomas from within the cranium and spine have distinct genetic profiles. Classic and anaplastic ependymomas with gain of 1q tended to occur in the posterior fossa of children and to behave aggressively. Our extensive data on ependymomas demonstrate significant associations between genetic aberrations and clinicopathological variables, and represent a starting point for further biological and clinical studies.

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Adjuvant chemotherapy of childhood posterior fossa ependymoma: Cranio-spinal irradiation with or without adjuvant CCNU, vincristine, and prednisone: A Childrens Cancer Group study

Evans

Anderson

Lefkowitz-Boudreaux

et al. 1996

Med. Pediatr. Oncol.

137

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Intracranial ependymoma: Long-term results of a policy of surgery and radiotherapy

Cited by 142 publications

References 23 publications

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

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

Genetic abnormalities detected in ependymomas by comparative genomic hybridisation

Adjuvant chemotherapy of childhood posterior fossa ependymoma: Cranio-spinal irradiation with or without adjuvant CCNU, vincristine, and prednisone: A Childrens Cancer Group study

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