Ependymomas of the filum terminale: The role of surgery and radiotherapy

Abstract

Background:Ependymomas of the filum terminale (EFT) form a specific and relatively uncommon subtype of spinal cord ependymomas. Most series in the literature are small, spanning a large time period. Up to date no consensus has been reached about the optimal treatment of these lesions. Some authors promote postoperative radiotherapy for all cases, others advocate postoperative radiotherapy only when a subtotal resection is performed or when metastasis are apparent.Methods:We performed a retrospective analysis of 22 patients with an EFT (mean age at diagnosis of 35.6 years).Results:In all patients (9/22) with lesions smaller than 4.5 cm no metastases were present and a complete resection could be obtained. No adjuvant radiotherapy was performed and at latest follow they had an excellent outcome. In our series, these initial tumor characteristics were more important regarding prognosis than either histology or treatment-related factors. For the larger tumors, total resection was obtained less frequently, more dissemination was diagnosed and a worse outcome was scored. Radiotherapy if indicated did lead to an acceptable disease control.Conclusion:In every case of EFT, an individual treatment protocol has to be outlined, but if an EFT is relatively small and can be resected completely, we would advocate to withhold radiotherapy.

Management and outcome analysis of conus and filum ependymoma: A tertiary center study

“…The goal of surgical resection is en bloc tumor removal along with preservation of neurovascular structures. [71216] With meticulous planning and diligent surgery using microneurosurgical techniques, it is possible to achieve gross total resection in most cases of CFE; all cases were operated using a posterior approach either through a laminectomy or a laminoplasty. Celli et al noted that gross total resection could be carried out in 43% of cases.…”

“…Radiotherapy is also advocated in case of recurrence and even for piecemeal excision; however, these indications remain controversial. [37813161920] In 2011, Chao et al observed postoperative radiotherapy delayed recurrence in their study involving 37 cases myxopapillary[20] radiation therapy also been used in CNS metastasis; however, this is another area of controversy. Anecdotal reports of chemotherapy are available for cases of ependymomas in those nonoperable or recurrent cases and refractory to radiation therapy; however, most authors do not advocate chemotherapy as a routine.…”

Adjunctive treatment of myxopapillary ependymoma running head: Myxopapillary ependymoma

“…The side effects of surgery depend on the type and location of the tumor. 10 In adjuvant treatments where radiation therapy is employed in addition to surgery, long-term survival after total tumor resection was approximately 40%. 11 …”

Surgery for Primary Filum Terminale Ependymomas: Outcome and Prognostic Factors

“…Thus, these studies cannot reveal the real outcome of PFTEs. Only few series of pure PFTEs have been studied and the sample size was always small , and the clinical features and prognostic factors are unclear and controversial in some aspects.…”