Long-term outcomes of spinal ependymomas: an institutional experience of more than 60 cases
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CLINICAL STUDY
Long‑term outcomes of spinal ependymomas: an institutional experience of more than 60 cases Rohan Savoor1 · Timothy L. Sita1 · Nader S. Dahdaleh2 · Irene Helenowski3 · John A. Kalapurakal1 · Maryanne H. Marymont1 · Rimas Lukas4 · Timothy J. Kruser1 · Zachary A. Smith5 · Tyler Koski2 · Aruna Ganju2 · Sean Sachdev1 Received: 15 September 2020 / Accepted: 30 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Spinal ependymomas represent the most common primary intramedullary tumors for which optimal management remains undefined. When possible, gross total resection (GTR) is often the mainstay of treatment, with consideration of radiotherapy (RT) in cases of residual or recurrent tumor. The impact of extent of resection and radiotherapy remain understudied. Objective Report on a large institutional cohort with lengthy follow-up to provide information on long-term outcomes and to contribute to limited data assessing the value of extent of resection and RT. Methods Patients with pathologically proven primary spinal ependymoma between 1990 and 2018 were identified. KaplanMeier estimates were used to calculate progression-free survival (PFS); local-control (LC) and overall survival (OS). Logistic regression was used to analyze variables’ association with receipt of RT. Results We identified 69 patients with ependymoma of which 4 had leptomeningeal dissemination at diagnosis and were excluded. Of the remaining cohort (n = 65), 42 patients (65%) had Grade II spinal ependymoma, 20 (31%) had Grade I myxopapillary ependymoma and 3 (5%) had Grade III anaplastic ependymoma; 54% underwent GTR and 39% underwent RT. With a median follow-up of 5.7 years, GTR was associated with improved PFS. For grade II lesions, STR+RT yielded better outcomes than STR alone (10y PFS 77.1% vs 68.2%, LC 85.7% vs 50%). Degree of resection was the only significant predictor of adjuvant radiotherapy (p < 0.0001). Conclusion Our findings confirm the importance of GTR in spinal ependymomas. Adjuvant RT should be utilized in the setting of a subtotal resection with expectation of improved disease-related outcomes. Keywords Ependymoma · Radiotherapy · Resection · Spine · Surgery
Introduction Spinal ependymomas have an incidence of 1 in 100,000, representing 30–45% of primary intramedullary spinal cord tumors [1, 2]. The WHO has identified three histologic
* Sean Sachdev [email protected] 1
Department of Radiation Oncology, Northwestern Lou and Jean Malnati Brain Tumor Institute, Northwestern University Robert H. Lurie Comprehensive Cancer Center, 676 N. St Clair Street, Suite 1820, Chicago, IL 60611, USA
Department of Neurological Surgery, Northwestern Lou and Jean Malnati Brain Tumor Institute, Northwestern University Robert H. Lurie Comprehensive Cancer Center, 676 N. St Clair Street, Suite 2200, Chicago, IL 60611, USA
2
grades of ependymomas: myxopapillary and subependymomas (Grade 1), classic ependymomas including papillary, clear cell, and tanycytic subtypes
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