paediatrics Brussels 17

J Neurooncol DOI 10.1007/s11060-006-9310-2

CLINICAL–PATIENT STUDIES

Long term outcome with post-operative radiation therapy for spinal canal ependymoma

Sasha H. Wahab Æ Joseph R. Simpson Æ Jeff M. Michalski Æ David B. Mansur

Received: 1 November 2006 / Accepted: 28 November 2006 Springer Science+Business Media B.V. 2007

and 64%, respectively. Patients with tumors larger than 6.0 cm at time of presentation demonstrated 5- and 10-year PFS of 58.3% compared to 92.3% for patients with tumors 6.0 cm or smaller ( P = 0.047). There was no significant correlation between tumor size and OS. Conclusions Post-operative radiation after subtotal resection is safe and offers durable tumor control and long term patient survival.

Abstract Purpose

A retrospective study was performed to evaluate the long term efficacy and safety of post- operative radiation therapy in the management of spinal canal ependymoma at our institution. Methods and materials Between 1954 and 1997, 22 patients with spinal canal ependymoma were treated with post-operative radiotherapy at our institution. The median age at diagnosis was 34.7 years (range 9.8–56.1 years). All patients underwent open biopsy with histologic diagnosis: 13 patients (59%) had ependymoma (WHO Grade II) and 9 patients (41%) had myxopapillary ependymoma (WHO Grade I). The median tumor size was 4.0 cm (range 1.5– 15.0 cm). Twenty patients received subtotal resection and 2 patients received gross-total resection. Median radiation dose was 45.0 Gy. Results The median follow up for surviving patients was 11.4 years (range 0.6–37.0 years). An 80% progression-free-survival (PFS) was observed for all patients at 5-, 10- and 15-year endpoints. All recurrences were within 3 years of treatment. The 5-, 10- and 15-year overall-survivals (OS) for all patients were 85%, 78%

Keywords Spinal cord

Ependymoma Radiation Spinal canal

Introduction

Primary spinal canal tumors comprise approximately 15% of all primary central nervous system (CNS) tumors [ 1 ]. Ependymomas are the most common neu- roepithelial neoplasm in the spinal canal, comprising 50–60% of spinal gliomas [ 2 ]. Spinal canal ependy- momas have long been characterized as slow-growing tumors with a predominantly local growth pattern, a high rate of local recurrence and a favorable long term survival. Ependymomas are classified by histologic grade as subendymoma (WHO Grade I), myxopapil- lary ependymoma (WHO Grade I), ependymoma (WHO Grade II); and anaplastic ependymoma (WHO Grade III) [ 3 ]. Without prospective randomized trials on this rare tumor, management of primary spinal canal ependy- momas is largely based on single institution historical data. Surgery is generally the first line of therapy, and serves the dual purpose of tissue diagnosis and gross tumor excision. The use of adjuvant therapy varies by institution due to uncertainty with regard to the need

S. H. Wahab J. R. Simpson J. M. Michalski D. B. Mansur ( & ) Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, Lower Level, St. Louis, MO 63110, USA e-mail: mansur@radonc.wustl.edu S. H. Wahab J. R. Simpson J. M. Michalski D. B. Mansur Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA

123