Long term outcomes following surgical resection of myxopapillary ependymomas

Bagley, Carlos A.; Wilson, Sean R.; Kothbauer, Karl F.; Bookland, Markus J.; Epstein, Fred J.; Jallo, George I.

doi:10.1007/s10143-009-0190-8

Cited by 96 publications

(102 citation statements)

References 55 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Bagley and colleagues 7 and Chao and colleagues 11 demonstrated no benefit in recurrence-free survival for patients treated with adjuvant radiotherapy after surgery. Akyurek and colleagues, 2 on the other hand, found that adjuvant radiotherapy was associated with better outcomes for both patients who underwent GTR and those who underwent STR.…”

Section: ©Aans 2013mentioning

confidence: 99%

“…Myxopapillary ependymomas appear to be particularly aggressive in these younger individuals. 7,27 Consensus on optimal surgical and/or adjuvant treatment will depend on which of these modalities provides maximal tumor control. It is unlikely that a randomized controlled clinical trial will be designed to conclusively answer this question.…”

Section: ©Aans 2013mentioning

confidence: 99%

“…The majority of studies have been limited by small sample sizes: The largest published series to date included 85 patients with MPE, 27 and only 3 others included more than 40. 7,19,35 In the modern era, 2 main areas of controversy in the treatment of MPEs have emerged. The first concerns the relative benefit of gross-total resection (GTR) of the tumor compared with subtotal resection (STR).…”

mentioning

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: ©Aans 2013mentioning

confidence: 99%

Section: ©Aans 2013mentioning

confidence: 99%

mentioning

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

“…pinal cord ependymomas are slow growing, not very infiltrative, and well-demarcated tumors of neuroectodermal origin arising from ependymal cells in the central canal of the spinal cord and filum terminale, 1,8,21,26,31,40 or even from heterotopic ependymal cells in the spinal canal. 5,37 These ependymomas occur more frequently in middle age (40-60 years of age) and represent 60% of cases of intramedullary spinal cord tumors.…”

mentioning

confidence: 99%

Outcomes in treatment for primary spinal anaplastic ependymomas: a retrospective series of 20 patients

Liu

Sun²,

Qi³

et al. 2013

SPI

View full text Add to dashboard Cite

Object Little is known regarding the anaplastic variant of primary ependymomas that involve the spinal cord. The aim of this study was to evaluate the clinical characteristics and treatment outcomes of primary spinal anaplastic ependymomas (PSAEs). Methods Medical records were reviewed in 20 patients with pathologically proven PSAEs who underwent surgical treatment at the Department of Neurosurgery in Huashan Hospital between 1999 and 2008. Results This series included 7 women and 13 men between the ages of 2 and 67 years (mean 31.9 years). The mean preoperative course was 9.3 months (range 20 days to 48 months). The most common PSAE locations were the cervical and thoracic spinal cords. The most common presenting symptom was weakness, followed by numbness, bowel or bladder dysfunction, and pain. Gross-total resection (GTR) was achieved in 17 patients, and a subtotal removal was performed in 3 patients. Nine patients received radiation therapy and/or chemotherapy. The mean follow-up duration was 83.5 months. Functional assessment of the 10 patients available at the latest follow-up evaluation showed that 2 had worsened and 8 remained unchanged from their preoperative status. There were 2 local recurrences and 1 lung metastasis. Conclusions Patients with PSAEs presented with a much shorter preoperative course than patients with Grade II ependymomas in previous studies. Patients with tumors that involved the cervical spinal cord experienced a worse outcome. Surgical removal of PSAEs, with the goal of GTR, is beneficial to patients. The role of radiation therapy and chemotherapy in PSAEs remains to be determined in further studies.

show abstract

“…Although there is evidence that Grade I ependymomas are more aggressive in children compared with adults, 5,38,45 our institutional experience suggests that GTR can be achieved safely, in Table 1). Sagittal pre-(A) and postoperative (B) T1-weighted MR images after contrast administration from a patient with a spinal Grade II (classic) ependymoma.…”

Section: Discussionmentioning

confidence: 83%

Surgical outcomes in spinal cord ependymomas and the importance of extent of resection in children and young adults

Safaee¹,

Mummaneni

et al. 2014

PED

View full text Add to dashboard Cite

Object Ependymomas are a common type of CNS tumor in children, although only 13% originate from the spinal cord. Aside from location and extent of resection, the factors that affect outcome are not well understood. Methods The authors performed a search of an institutional neuropathology database to identify all patients with spinal cord ependymomas treated over the past 20 years. Data on patient age, sex, clinical presentation, symptom duration, tumor location, extent of resection, use of radiation therapy, surgical complications, presence of tumor recurrence, duration of follow-up, and residual symptoms were collected. Pediatric patients were defined as those 21 years of age or younger at diagnosis. The extent of resection was defined by the findings of the postoperative MR images. Results A total of 24 pediatric patients with spinal cord ependymomas were identified with the following pathological subtypes: 14 classic (Grade II), 8 myxopapillary (Grade I), and 2 anaplastic (Grade III) ependymomas. Both anaplastic ependymomas originated in the intracranial compartment and spread to the spinal cord at recurrence. The mean follow-up duration for patients with classic and myxopapillary ependymomas was 63 and 45 months, respectively. Seven patients with classic ependymomas underwent gross-total resection (GTR), while 4 received subtotal resection (STR), 2 received STR as well as radiation therapy, and 1 received radiation therapy alone. All but 1 patient with myxopapillary ependymomas underwent GTR. Three recurrences were identified in the Grade II group at 45, 48, and 228 months. A single recurrence was identified in the Grade I group at 71 months. The mean progression-free survival (PFS) was 58 months in the Grade II group and 45 months in the Grade I group. Conclusions Extent of resection is an important prognostic factor in all pediatric spinal cord ependymomas, particularly Grade II ependymomas. These data suggest that achieving GTR is more difficult in the upper spinal cord, making tumor location another important factor. Although classified as Grade I lesions, myxopapillary ependymomas had similar outcomes when compared with classic (Grade II) ependymomas, particularly with respect to PFS. Long-term complications or new neurological deficits were rare. Among patients with long-term follow-up, those who underwent GTR had a recurrence rate of 20% compared with 40% among those with STR or biopsy only, suggesting that extent of resection is perhaps a more important prognostic factor than histological grade in predicting PFS, which has been suggested by other data in the literature. Given the relative paucity of these lesions, collaborative multiinstitutional studies are needed, and such efforts should also focus on molecular and genetic analysis to refine the current classification system.

show abstract

Long term outcomes following surgical resection of myxopapillary ependymomas

Cited by 96 publications

References 55 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

Outcomes in treatment for primary spinal anaplastic ependymomas: a retrospective series of 20 patients

Surgical outcomes in spinal cord ependymomas and the importance of extent of resection in children and young adults

Contact Info

Product

Resources

About