1573 / 1708
One patient received chemotherapy as a component of
initial treatment (dianhydrogalactitol, triazinate, etoposide,
Table 3). Salvage chemotherapy was administered to 8
patients when disease progression was documented after
initial treatment. Various combinations of the following
agents were administered: dianhydrogalactitol, triazinate,
etoposide, semustine, procarbazine, diaziquone, vincristine,
prednisone, cis-platin, and methotrexate.
RESULTS
Patterns of failure
Local control rates at 5 and 10 years were 75% and 70%,
respectively. The 5-year local control rates were 83% for
patients with low-grade tumors as compared to 20% for
those with high-grade tumors (
p
,
0.0001) (Fig. 1). Patients
with primary tumors measuring less than 3.5 cm in diameter
had a 5-year local control rate of 80% as compared to 70%
for larger tumors (
p
5
0.049) (Fig. 2). Additional factors
evaluated and not significantly associated with local control
included the extent of resection, radiation dose, field ar-
rangement, patient age, sex, or the histologic subtype
(myxopapillary vs. others).
Leptomeningeal dissemination following therapy oc-
curred in 7 of 70 patients (10%) with low-grade tumors and
3 of 10 patients (30%) with high-grade tumors. The actu-
arial 5-year leptomeningeal failure rates were 10% for pa-
tients with low-grade tumors as compared to 41% for those
with high-grade tumors (
p
5
0.01) (Fig. 3). Radiotherapy
field arrangement did not significantly alter the risk of
leptomeningeal seeding. The 5-year leptomeningeal failure
rate was 9% for those treated with local fields, 11% for
those treated with whole brain or whole spine fields, and
24% for those treated with craniospinal axis fields (
p
5
0.4).
Patterns of failure for both low- and high-grade tumors were
evaluated in detail (Table 4). The predominant pattern of
failure was local failure, which was sometimes accompa-
nied by leptomeningeal failure. Isolated leptomeningeal
failures were uncommon, occurring in only 5% of patients.
Only one patient failed in non-CNS sites (scalp, lungs, and
kidneys). This individual developed leptomeningeal seeding
prior to widespread metastases.
Survival
Actuarial 5-, 10-, and 15-year survival rates for the entire
study group were 79%, 73%, and 61%, respectively (Fig. 4).
Tumor size, patient age, sex, radiotherapy field arrange-
ment, and radiation dose were not significantly associated
Fig. 1. Freedom from local failure by tumor grade (1 and 2 vs. 3
and 4).
Fig. 2. Freedom from local failure by tumor size.
Fig. 3. Freedom from leptomeningeal failure by tumor grade (1
and 2 vs. 3 and 4).
955
Ependymomas
●
S. E. S
CHILD
,
et al.