The importance of surgery in supratentorial ependymomas

Palma, Lucio; Celli, Paolo; Mariottini, Aldo; Zalaffi, Alessandro; Schettini, Giuseppe

doi:10.1007/s003810050487

Cited by 95 publications

(73 citation statements)

References 28 publications

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“…Recently, a number of smaller series have reported positive outcomes in children 20,27,28,[35][36][37][38][39][40] or adults 15 with totally resected Grade 2 intracranial ependymoma who did not receive RT after surgery. Reserving RT for recurrent disease appears to be an attractive strategy for patients with Grade 2 ependymoma, provided that the behavior of this malignancy is similar to that of lowgrade glioma, in which no detrimental impact on OS was observed when a 'wait and see' policy was followed after surgery.…”

Section: Treatmentmentioning

confidence: 99%

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: Treatmentmentioning

confidence: 99%

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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“…Clinical and biological perspective, the ependymomas of doi: 10.7243/2055-091X-2-17 childhood and in adults remain enigmatic about the treatment [8][9][10]. There are good prognostic factors, that including; age of the patient, tumors location, surgical resection [5,6].…”

Section: Discussionmentioning

confidence: 99%

“…The identification of biological correlates of outcome and therapeutic targets remains a significant challenge in this disease [8,9].…”

Section: Introductionmentioning

confidence: 99%

“…Ependymoma is usually considered non-infiltrative tumor [3][4][5][6][7][8]. The location of the tumor is an important factor for prognosis [8,9].…”

Section: Introductionmentioning

confidence: 99%

“…Classical WHO, grade I including; Myxopapillary ependymoma (MPE) that occur in the phylum terminalis of the spinal cord, grade II ependymoma (include cellular, papillary, tanacytic, giant cell, epithelioid, and clear cell variants) and grade III corresponding the anaplastic ependymoma subtype [1]. Different histological or immunohistochemical criteria have been proposed as prognostic factors [3][4][5][6][7] and [8]. However, WHO classification, extent of surgical resection are the most important variable in predicting outcome [8,9].…”

Section: Introductionmentioning

confidence: 99%

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Expression of glial acidic fibrillary protein delta and E-cadherin in ependymomas; clinic-pathological and immunohistochemistry correlation

Tena-Suck¹,

Castillejos-López²,

Díaz-Alba³

et al. 2015

J Histol Histopathol

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Background: Ependymoma is a tumor that formed from the ependyma. Usually, in paediatric cases the location is intracranial, while in adults it is spinal. Methods: We study the prognostic implications of the current grading system, of histological and immunohistochemical features of GFAP, GFAP-δ, EMA, neurofilament and E-cadherin expression and Ki-67 in ependymomas. Results: 60 cases were included in this study of which 32 were female and 28 were male, aging ranged from 18 to 65 years old (mean age of 34.18±11.35 yr). 17 were supratentorial, 25 infratentorial and 18 cases were spinal location. Histologically 15 were grade 1, 36 were grade II and 9 grade III. 23 cases recurrence (4, 13 and 6 stage III respectively), with mean age 34.52±12.23 years vs 33.97±97.94 that not recurrence. The expression of GFAP-δ was negative in 38 cases and positive in 21(p=0.359). GFAP-δ expression was correlated with anaplastic type (grade III). Tumor grade and tumor size, brain invasion, atypia, and mitosis features and also were correlated with higher expression of neurofilament, higher ki-67-Li, as well as loss of immnunoexpression of E-Cadherina and EMA. Conclusions: PGAF, S-100, and GFAP-δ expression in ependymomas varied and depends of the histologic grade likewise the value of proliferation index. The expression of GFAP-δ was in directly relationship with presence of neurofilament and loss of E-Cadherins and EMA expression. Studies have suggested that human ependimomas arise from regionally distinct populations of radial glial cells.

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Supratentorial extraventricular ependymal neoplasms

Shuangshoti

Rushing

Mena

et al. 2005

Cancer

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Objective Transient amnesia can be the principal manifestation of epilepsy. This diagnosis, however, is seldom suspected by clinicians and remains controversial. The amnestic attacks are often associated with persistent memory complaints. This study was designed to provide the first description of transient epileptic amnesia in a substantial series of patients. Methods Fifty patients were recruited over 18 months using the following diagnostic criteria: (1) recurrent, witnessed episodes of amnesia; (2) other cognitive functions intact during attacks; and (3) compelling evidence of epilepsy. We assessed clinical features and performed neuropsychological evaluation in cases and 24 matched control subjects. Results Transient epileptic amnesia develops in later life (mean onset, 62 years). Amnestic episodes are frequent (median, 12/year), brief (median duration, 30–60 minutes), and often occur on waking (37/50 cases). Epilepsy was the initial specialist diagnosis in only 12 of 50 cases. Attacks ceased on anticonvulsant medication in 44 of 47 treated patients. A total of 40 of 50 cases described persistent memory difficulties. Despite normal performance on standard memory tests, patients exhibited accelerated forgetting of verbal and visual material over 3 weeks by comparison with matched control subjects (p < 0.001). They also showed loss of autobiographical memories for events extending back over 40 years (p < 0.05). Interpretation We propose that transient epileptic amnesia is a distinctive epilepsy syndrome, typically misdiagnosed at presentation and associated with accelerated long‐term forgetting and autobiographical amnesia. The syndrome is of clinical and theoretic importance. Ann Neurol 2007

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The importance of surgery in supratentorial ependymomas

Cited by 95 publications

References 28 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

Expression of glial acidic fibrillary protein delta and E-cadherin in ependymomas; clinic-pathological and immunohistochemistry correlation

Supratentorial extraventricular ependymal neoplasms

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