paediatrics Brussels 17

1577 / 1708

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
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%
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.
Keywords Ependymoma Radiation Spinal canal
Spinal cord
Introduction
Primary spinal canal tumors comprise approximately
15% of all primary central nervous system (CNS)
tumors ]. Ependymomas are the most common neu-
roepithelial neoplasm in the spinal canal, comprising
50–60% of spinal gliomas ]. 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) ].
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:
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
J Neurooncol
DOI 10.1007/s11060-006-9310-2