Postoperative radiotherapy of intracranial ependymoma in pediatric and adult patients

Shaw, Edward G.; Evans, Richard G.; Scheithauer, Bernd W.; Ilstrup, Duane M.; Earle, John D.

doi:10.1016/0360-3016(87)90310-5

Cited by 148 publications

(104 citation statements)

References 12 publications

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“…Postoperative radiation has become commonplace in the management of anaplastic intracranial ependymomas. 20,46,48,54 However, Vera-Bolanos et al and our study, the 2 largest series evaluating prognostic factors, did not find a benefit to postoperative radiation. Further clinical investigation will be needed to determine the efficacy of radiation treatment in hemispheric ependymomas.…”

contrasting

confidence: 58%

“…1,37,57 Reported prognostic factors include age, Karnofsky performance status, tumor location, tumor grade, extent of resection (EOR), and postoperative radiation. 8,9,[19][20][21][22][46][47][48]54 Evidence supports the idea that supratentorial ependymomas have a worse prognosis than infratentorial tumors do in adults. 9,19,20,23,38,45,46 Additional data indicate that patients with hemispheric ependymomas have decreased PFS and OS compared with tumors occurring in the third or lateral ventricles.…”

mentioning

confidence: 68%

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Supratentorial hemispheric ependymomas: an analysis of 109 adults for survival and prognostic factors

Hollon¹,

Nguyen

Smith³

et al. 2016

JNS

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IntracranIal ependymomas are the third most common glioma in adults, behind astrocytomas and oligodendrogliomas. Ependymomas constitute 3% of primary CNS tumors and 6.7% of gliomas diagnosed each year in the US. 31,32 Safe maximal resection remains the mainstay of treatment. Radiation and chemotherapy may be provided as adjuvant treatments, especially in the setting of subtotal resection (STR). Reported 5-year overall survival (OS) rates for adults with intracranial ependymoma range widely from 35% to 90%. 9,19,21,47,54 Controversy exists regarding important prognostic factors for progression-free survival (PFS) and OS. 1,37,57 Reported prognostic factors include age, Karnofsky performance status, tumor location, tumor grade, extent of resection (EOR), and postoperative radiation. 8,9,[19][20][21][22][46][47][48]54 Evidence supports the idea that supratentorial ependymomas have a worse prognosis than infratentorial tumors do in adults. 9,19,20,23,38,45,46 Additional data indicate that patients with hemispheric ependymomas have decreased PFS and OS compared with tumors occurring in the third or lateral ventricles. 9,45 Although often considered an intraventricular tumor, more than half of supratentorial epabbreviatioNs EOR = extent of resection; GTR = gross total resection; OS = overall survival; PFS = progression-free survival; STR = subtotal resection. obJective Survival rates and prognostic factors for supratentorial hemispheric ependymomas have not been determined. The authors therefore designed a retrospective study to determine progression-free survival (PFS), overall survival (OS), and prognostic factors for hemispheric ependymomas. methods The study population consisted of 8 patients from our institution and 101 patients from the literature with disaggregated survival information (n = 109). Patient age, sex, tumor side, tumor location, extent of resection (EOR), tumor grade, postoperative chemotherapy, radiation, time to recurrence, and survival were recorded. Kaplan-Meier survival analyses and Cox proportional hazard models were completed to determine survival rates and prognostic factors. results Anaplastic histology/WHO Grade III tumors were identified in 62% of cases and correlated with older age. Three-, 5-, and 10-year PFS rates were 57%, 51%, and 42%, respectively. Three-, 5-, and 10-year OS rates were 77%, 71%, and 58%, respectively. EOR and tumor grade were identified on both Kaplan-Meier log-rank testing and univariate Cox proportional hazard models as prognostic for PFS and OS. Both EOR and tumor grade remained prognostic on multivariate analysis. Subtotal resection (STR) predicted a worse PFS (hazard ratio [HR] 4.764, p = 0.001) and OS (HR 4.216, p = 0.008). Subgroup survival analysis of patients with STR demonstrated a 5- and 10-year OS of 28% and 0%, respectively. WHO Grade III tumors also had worse PFS (HR 10.2, p = 0.004) and OS (HR 9.1, p = 0.035). Patients with WHO Grade III tumors demonstrated 5- and 10-year OS of 61% and 46%, respectively. Postoperative radiation was not prognostic f...

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contrasting

confidence: 58%

mentioning

confidence: 68%

Supratentorial hemispheric ependymomas: an analysis of 109 adults for survival and prognostic factors

Hollon¹,

Nguyen

Smith³

et al. 2016

JNS

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“…Survival rates for children with posterior fossa ependymomas have been reported in recent series to be 20% 16 , 44.6% 7 , 56% 20 and 52% 17 at 5 years. Young adults with fourth ventricle ependymomas may have a better prognosis 18 than children, although in some series, this difference has not been statistically significant 19,20,21 .…”

Section: Dicussionmentioning

confidence: 90%

Anaplastic ependymoma of the fourth ventricle causing obstrictive hydrocephalus

Iddrissu

Dakurah²,

Wepeba³

2006

Ghana Medical Journal

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SUMMARYEpendymomas are relatively uncommon and present with a spectrum of biological and clinical characteristics that make specific recommendations regarding their treatment difficult and assignment of prognostic factors controversial. The case of fourth ventricular anaplastic epednymoma in a four-year-old child is reported in which the initial presentation was deterioration of the level of consciousness secondary to acute obstructive hydrocephalus. An initial insertion of a ventriculoperitoneal shunt (V-P) to deal with the acute intracranial hypertension was done. Subsequently, sub-occipital craniectomy and sub-total resection of the tumour were performed successfully. Postoperative radiotherapy was also undertaken on the patient. The pertinent literature is reviewed. At one year follow up our patient had clinically improved with no signs of recurrence. The most important prognostic factors are tumour grade and the presence of residual tumour on post operative imaging studies. A median survival of 31 months is noted in children with infratentorial ependymomas and one year survival is quoted as 81%.

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“…In fact, treatment failure can predominantly occur at the local site, rather than distant locations. 24,[27][28][29] To achieve better local control, repeat surgery should be considered, but this approach carries a higher risk of inducing neurological deficits and dissemination, which may impair a patient's PS. 18 Leptomeningeal dissemination is also a strong indicator of a poor prognosis.…”

confidence: 99%

“…Previous reports have indicated that the primary tumor site is the predominant site of treatment failure. 25,[27][28][29] However, tumors located in eloquent areas are sometimes treated with subtotal resection to prevent impairment of PS. Meticulous follow-up is essential for early detection of local tumor recurrence to decide the appropriate timing of reoperation.…”

Section: Figmentioning

confidence: 99%

Clinical significance and limitations of repeat resection for pediatric malignant neuroepithelial tumors

Kawaguchi

Kumabe

Saito

et al. 2013

PED

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Object Maximized tumor resection and minimized surgical morbidity are extremely important in the treatment of children with malignant neuroepithelial tumors. However, the indications for repeat surgery for these tumors remain unclear. The present study investigated the clinical significance and limitations of repeat resection for these tumors. Methods This study included 61 consecutive pediatric patients with malignant neuroepithelial tumor, histologically diagnosed as WHO Grades III and IV. All patients were initially treated between January 1997 and March 2011 and had follow-up of more than 2 years. The number of surgeries, presence of leptomeningeal dissemination, survival, WHO grade, and Eastern Cooperative Oncology Group performance status before and after surgery were retrospectively reviewed. Results Repeat resections were performed for 21 patients (34.4%). Eastern Cooperative Oncology Group performance status was not aggravated by surgery, even after multiple operations. The 5-year survival rates of patients who received single and repeat surgery were 58.6% and 38.7%, respectively (p = 0.12). The mean interval between initial surgery and leptomeningeal dissemination detection was 331 ± 108 days in the single-surgery group and 549 ± 122 days in the repeat-surgery group (p = 0.19). The median survival time after leptomeningeal dissemination was 580 days in the single-surgery group and 890 days in the repeat-surgery group (p = 0.74). Conclusions Repeat resection with minimized surgical morbidity is an effective method to achieve better local control of pediatric malignant neuroepithelial tumors. Leptomeningeal dissemination was a leading cause of death, but repeat surgery did not increase the frequency of death.

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Postoperative radiotherapy of intracranial ependymoma in pediatric and adult patients

Cited by 148 publications

References 12 publications

Supratentorial hemispheric ependymomas: an analysis of 109 adults for survival and prognostic factors

Supratentorial hemispheric ependymomas: an analysis of 109 adults for survival and prognostic factors

Anaplastic ependymoma of the fourth ventricle causing obstrictive hydrocephalus

Clinical significance and limitations of repeat resection for pediatric malignant neuroepithelial tumors

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