paediatrics Brussels 17

J Neurooncol (2006) DOI 10.1007/s11060-006-9169-2

ORIGINAL PAPER

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

Serap Akyurek Æ Eric L. Chang Æ Tse-Kuan Yu Æ Darrin Little Æ Pamela K. Allen Æ Ian McCutcheon Æ Anita Mahajan Æ Moshe H. Maor Æ Shiao Y. Woo

Received: 9 March 2006 / Accepted: 29 March 2006 Springer Science+Business Media B.V. 2006

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, adju- vant RT appears to significantly reduce the rate of tumor progression. Failures occurred exclusively in the neural axis, mainly at the primary site.

Abstract This study was undertaken to determine the disease outcomes in patients treated with surgery alone or surgery and adjuvant radiotherapy (RT) for myxo- papillary ependymoma (MPE) of the spine. The med- ical 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 dis- ease 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 S. Akyurek Æ E. L. Chang ( & ) Æ T.-K. Yu Æ D. Little Æ P. K. Allen Æ A. Mahajan Æ M. H. Maor Æ S. Y. Woo Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., # 97, Houston, TX 77030, USA e-mail: echang@mdanderson.org S. Akyurek Department of Radiation Oncology, Ankara University School of Medicine, Ankara, Turkey I. McCutcheon Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA

Keywords Myxopapillary ependymoma Æ Ependymoma Æ Spinal tumor Æ Surgery Æ Radiotherapy

Introduction

Ependymomas are the most common intraspinal tumors [1], representing 15% of spinal cord tumors and up to 60% of spinal cord gliomas [2, 3]. Myxopapillary ependymomas (MPEs), first described in 1932 by Kernohan [4], are a distinctive variant of ependymo- mas both clinicopathologically and genetically [5, 6]. According to the World Health Organization classifi- cation of central nervous system tumors, MPEs are grade I tumors [7]. MPEs are usually histologically benign, often encapsulated, and slow-growing tumors with a long disease course. The incidence of MPE is low; in a large series of cases of ependymomas, only 13% were found to be of the myxopapillary type [8]. Most MPEs occur in the lumbosacral/cauda equina region. Occasionally, MPEs arising from other sites in the spinal cord, from the intracranial region, or from the subcutaneous soft tissues in the sacrococcygeal region have been described [9–13]. Most spinal ependymoma series published in the literature have included only patients with spinal

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