Is gross-total resection sufficient treatment for posterior fossa ependymomas?

Rogers, Leland; Pueschel, Jeanette K.; Spetzler, Robert F.; Shapiro, William R.; Coons, Stephen W.; Thomas, Theresa Currier; Speiser, Burton L.

doi:10.3171/jns.2005.102.4.0629

Cited by 94 publications

(68 citation statements)

References 41 publications

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“…A retrospective study of ependymoma patients from the Barrow Neurological Institute included 73% of the cohort greater than 18 years of age. The study found a 10 year local control rate of 100% for patients who underwent a gross total resection followed by radiation versus 50% for those who underwent gross total resection alone (P = 0.018) [3]. The heterogeneity in the utilization of post-operative radiation therapy in adults seen in this study is likely a result of patients not receiving care in a multi-disciplinary setting.…”

Section: Discussionmentioning

confidence: 94%

“…In the US, the current standard of care includes surgery with the goal of gross-total resection followed by post-operative irradiation using doses ranging from 54 to 59.4 Gy [2,3]. Past concerns regarding the long-term effects of irradiation in young children have led researchers to examine ways to delay or avoid its use in young children [4,5].…”

Section: Introductionmentioning

confidence: 99%

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Post-operative radiation improves survival in children younger than 3 years with intracranial ependymoma

et al. 2011

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Concerns regarding long-term toxicities have led to the avoidance of post-operative radiation (PORT) in young children with intracranial ependymoma. We investigated the association between post-operative radiation therapy and overall survival (OS) in children younger than 3 years and compared their survival to other age groups. The study sample from the SEER database included 804 patients with intracranial ependymoma, grades 2-3, and diagnosed between 1988 and 2005. OS was estimated using the Kaplan-Meier method, and hazard ratios (HR) and 95% confidence limits (CL) were calculated based on multivariable Cox proportional hazards models. A total of 804 patients were selected and PORT was administered to 35% of patients younger than 3 years. With a median follow-up of 3 years (range 0.1-18 years), the 3 year OS was 61% for children younger than 3 years, 83% for those ages 3-20 years, and 69% for patients older than 20 years (P < 0.001). In multivariable analysis, OS was significantly improved for patients receiving PORT (HR 0.8, 95% CL 0.6-0.9), and gross total resection (HR 0.6, 95% CL 0.5-0.8). Among children younger than 3 years, the 3 year OS was significantly greater among those who received PORT compared to those who did not (81% vs. 56%, respectively, P = 0.005). The majority of children younger than 3 years with intracranial ependymoma did not receive PORT. Children younger than 3 years who did not receive PORT had a relatively poor outcome, while those who received radiation therapy had a survival similar to older patients.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Post-operative radiation improves survival in children younger than 3 years with intracranial ependymoma

et al. 2011

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“…Gross total resection is more commonly achieved in supratentorial than in infratentorial ependymomas. The importance of thorough resection is well documented [1,4,7,10,11,12,13,14,18]. …”

Section: Discussionmentioning

confidence: 99%

“…Adjuvant radiotherapy following gross total resection of a posterior fossa ependymoma has been suggested to be beneficial in retrospective reviews [13,16], but adjuvant radiotherapy has not been subjected to the rigors of a randomized trial and thus remains disputable.…”

Section: Discussionmentioning

confidence: 99%

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Long-Term Survival following Gross Total Resection of Pediatric Supratentorial Ependymomas without Adjuvant Therapy

et al. 2012

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Pediatric supratentorial ependymoma is very rare. In pediatric patients with supratentorial ependymoma, surgery alone may be an acceptable treatment when postoperative imaging confirms a gross total resection. Surgical resection is the standard and the most important treatment for ependymoma. The role of radiation therapy and/or chemotherapy following a gross total resection of supratentorial ependymoma has been uncertain. We report 2 cases of pediatric supratentorial ependymomas treated by gross total resection without postoperative adjuvant therapy. The first patient was a 7-year-old girl who presented with motor weakness and a hemiconvulsion of the right leg. Magnetic resonance imaging (MRI) revealed a large heterogeneously enhanced tumor in the left frontal lobe. The second patient was an 8-year-old girl who presented with headache. MRI revealed a huge heterogeneously enhanced tumor in the left frontal lobe. Gross total resection was achieved in both patients. Postoperative radiotherapy and chemotherapy were avoided following gross total resection. Histologically, the lesions demonstrated grade II ependymoma and anaplastic ependymoma, respectively. After follow-up of 120 months, neither patient had recurrence or dissemination. These results suggest that patients with pediatric supratentorial ependymoma treated by gross total resection alone have a favorable outcome, and postoperative radiotherapy and chemotherapy may be avoided.

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Ependymomas

Raghav

Gilbert

2012

Neuro‐oncology

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Is gross-total resection sufficient treatment for posterior fossa ependymomas?

Cited by 94 publications

References 41 publications

Post-operative radiation improves survival in children younger than 3 years with intracranial ependymoma

Post-operative radiation improves survival in children younger than 3 years with intracranial ependymoma

Long-Term Survival following Gross Total Resection of Pediatric Supratentorial Ependymomas without Adjuvant Therapy

Ependymomas

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