Spinal myxopapillary ependymoma outcomes in patients treated with surgery and radiotherapy at M.D. Anderson Cancer Center

Abstract

This study was undertaken to determine the disease outcomes in patients treated with surgery alone or surgery and adjuvant radiotherapy (RT) for myxopapillary ependymoma (MPE) of the spine. The medical records of 35 patients with MPE treated at The University of Texas M.D. Anderson Cancer Center between December 1968 and July 2002 were reviewed. The endpoints analyzed were progression-free survival (PFS), overall survival, and local control. The median age of patients was 35 years (range, 14-63 years), and the male to female ratio was 2.5:1. In total, 21 (60%) patients underwent a gross total resection, 13 (37%) a subtotal resection, and 1 (3%) a biopsy only; 22 of them (63%) also received adjuvant RT. The median follow-up was 10.7 years. The 10-year overall survival, PFS, and local control rates for the entire group were 97%, 62%, and 72%, respectively. Of 11 patients 5 (45%) who had undergone gross total resection alone had recurrence. A total of 12 (34%) patients had disease recurrence, all in the neural axis; 8 of them had treatment failure at the primary site only, 3 in the distant neural axis only, and 1 at the primary site and in the distant neural axis. Patient age (> 35 years; P = 0.002) and adjuvant RT (P = 0.04) significantly affected PFS. The long-term patient survival duration for MPE managed with surgery and adjuvant RT is favorable. Regardless of the extent of resection, adjuvant RT appears to significantly reduce the rate of tumor progression. Failures occurred exclusively in the neural axis, mainly at the primary site.

Myxopapillary ependymoma: correlation of clinical and imaging features with surgical resectability in a series with long-term follow-up

“…5,8 Our data did not support a significant reduction in tumor recurrence/progression following postoperative radiation.…”

“…4 The long-term survival for MPE has been excellent, reported at 10 years as 97% for overall survival, and 62 and 72% for both progression-free survival and local control, respectively. 5 The degree of surgical resection has been shown to significantly alter the survival in spinal cord ependymoma. 4,5,11 However, that is controversial for MPE.…”

“…5 The degree of surgical resection has been shown to significantly alter the survival in spinal cord ependymoma. 4,5,11 However, that is controversial for MPE. In the landmark paper by Sonneland et al, 2 less recurrence (10%) was observed with gross total removal of encapsulated tumors when compared with those removed in piecemeal (34% recurrence) or subtotally resected tumors (41% recurrence).…”

“…The strategic location of MPE in the conus-cauda area, the tendency for these lesions to present late with extensive local disease and dense attachment to eloquent neural structures, has been shown to limit the completeness of surgical resection. 4,5 These anatomical limitations may also be associated with an increased risk of local recurrence, although previous reports have largely relied on plain or computed tomography-myelography (Table 1). 6 Magnetic resonance imaging (MRI) has evolved as the test of choice for both diagnosis of MPE and determination of the extent of tumor involvement to the neural elements.…”

Ependimomas del filum terminal. Análisis de 20 casos consecutivos

“…Se ha encontrado relación significativa con edad del paciente 1, , estado clínico 26 , afectación de esfínteres 38 , duración de los síntomas 6,11,26 , localización 26 , características de imagen con RM 34 , presencia o no de cápsula tumoral 34 , grado de resección tumoral 23,34 , tratamiento inicial y dosis de radioterapia 1 . Únicamente, Akyurek et al 1 en una serie de 35 pacientes encuentran como factores significativos de buen pronóstico la edad de los pacientes (<35 contra >35 años) y la modalidad de tratamiento inicial (cirugía contra cirugía y radioterapia).…”