Ependymoma : outcome and prognostic factors

Abstract EN

Purpose : this analysis was performed to identify risk factors for overall and relapse-free survival in ependymomas and to provide treatment recommendations.

Patients and Methods : Forty-eight ependymal patients, in the period from April 1994 to May 2002, were evaluated retrospectively.

The WHO classification was used for tumor subtyping and grading.

Follow-up ranged from 4 to 115 months (mean 29 months).

Results : there were 26 males (54 %) and 22 females (46 %).

Age ranged from 2-57 years (mean 22 ± 15).

Children constituted 52 % of the cases.

Ten patients had supratentorial lesions, 18 had infratentorial lesions and 20 had spinal cord lesions.

Thirty-seven (77 %) and 11 (23 %) patients had low and high-grade tumors, respectively.

Nine (82 %), out of the 11 cases with high-grade pathology were children.

Similarly, 73 % (8 patients) of those 11 cases were infrat-entorial.

Twenty-five patients had partial resection and 23 had gross total resection.

Forty-four patients had postoperative adjuvant external beam radiotherapy.

Of all the cases, 19 (40 %) experienced treatment failure, 17 at the primary site, one with spinal seedling and the last one outside the primary site.

At 10-years, survival rates were 79 % (absolute) and 53% (relapse-free).

Age and dose of radiotherapy proved to be of statistical significance with p values of 0.058 and 0.054, respectively.

Grade showed significant difference only when analyzed on bases of radiotherapy treatment volume.

Site and extent of surgery failed to be of significant difference.

Since CSF examination and the initial tumor size were not documented for 54 % and 45 % of the patients, respectively, we couldn’t evaluate their significance.

Conclusion : the primary tumor site is the most common site of failure.

Our current recommendation is to treat all supratentorial and low-grade infratentorial tumors with partial brain fields.

Craniospinal irradiation is to be reserved for those patients with high-grade infratentorial lesions and those with evidence of craniospinal seedling either radio logically or pathologically.

Investigation of biologic markers may provide additional information that allows further refinement of our prognostic ability and enable identification a cohort of patients at a higher risk for progression.