Intracranial ependymomas in children

Goldwein, Joel W.; Leahy, Joanna M.; Packer, Roger J.; Sutton, Leslie N.; Curran, Walter J.; Rorke, Lucy B.; Schut, Luis; Littman, P S; D’Angio, Giulio J.

doi:10.1016/0360-3016(90)90362-n

Cited by 171 publications

(108 citation statements)

References 14 publications

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“…Many studies had Grade II ependymomas that were up to two to three times more frequent than Grade III tumors. 3,4,6,9,11,14,15,17,20,22,24,25,30 In some studies this ratio was almost equal, 13,19,[33][34][35] while in others there were far more Grade III than Grade II ependymomas. 12,26,28,29,31,32 In one study of ependymomas in children under 5 years of age, the authors reported eight Grade II and 60 Grade III ependymomas.…”

Section: Pediatric Posterior Fossa Ependymomas T Tihan Et Almentioning

confidence: 96%

“…5,7,9,11,12,17,28,35 Therefore, we presume that the actual number of patients was fewer, but an accurate count was not possible since data were lacking on which patients were reanalyzed in different studies.…”

Section: Literature Reviewmentioning

confidence: 99%

“…Among 18 studies where the effect of age on survival was analyzed, 12 studies reported age at diagnosis as an independent prognostic factor. 4,7,[9][10][11]13,20,22,24,25,33,34 Six of these studies considered the cut-off for age groups as 3 years, two as 4 years, and one as 5 years of age. In one study, age was calculated as a continuous variable, and in another study of children younger than 3 years, the cut-off between two age groups was 2 years of age (24 months).…”

Section: Pediatric Posterior Fossa Ependymomas T Tihan Et Almentioning

confidence: 99%

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The prognostic value of histological grading of posterior fossa ependymomas in children: a Children's Oncology Group study and a review of prognostic factors

et al. 2008

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We performed a retrospective analysis of 96 pediatric posterior fossa ependymomas in order to determine the prognostic value of histological grade based on the current WHO grading scheme. The patients were selected among Children's Oncology Group (previously Pediatric Oncology Group-POG) patients enrolled in clinical trials, and on the basis of central pathology review, location, and age. We excluded entities such as subependymoma, myxopapillary, or clear-cell ependymoma, after a consensus diagnosis by three neuropathologists. A total of 66 males and 30 females with a median age of 48 months were identified. The group was analyzed to determine the effects of histological grade, age, gender, and extent of resection on event-free and overall survival. Our results showed that extent of resection, age, and histological grade were independent prognostic variables for event-free survival. The relative risk for extent of resection and histological grade was calculated as 3.59 (Po0.001) and 3.58 (Po0.001), respectively. Overall survival significantly correlated with extent of resection and age, but not with histological grade. We compared our results with peer-reviewed publications on pediatric intracranial ependymomas in the English language between 1990 and 2005. Selection criteria identified 32 manuscripts involving 1444 patients. Extent of resection was a significant factor in 21, age in 12, and histological grading in nine of these studies. Other factors reported to be significant by more than one study included tumor location and radiation treatment. Our findings suggest that histological grade (WHO Grade II vs III) is an independent prognostic indicator for event-free survival, but may not be so for overall survival in pediatric posterior fossa ependymomas. We believe that an accurate assessment of the prognostic value of histological grade depends on the selection of a well-characterized clinical cohort of sufficient size, and the inclusion of relevant histological criteria as outlined in the WHO classification scheme.

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Section: Pediatric Posterior Fossa Ependymomas T Tihan Et Almentioning

confidence: 96%

Section: Literature Reviewmentioning

confidence: 99%

Section: Pediatric Posterior Fossa Ependymomas T Tihan Et Almentioning

confidence: 99%

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The prognostic value of histological grading of posterior fossa ependymomas in children: a Children's Oncology Group study and a review of prognostic factors

et al. 2008

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“…4,5,9,11,15,30 Furthermore, supratentorial tumors exhibit higher mitotic activity than do infratentorial tumors. 31 Among patient-related factors, age Ͼ 40 years had a negative impact on survival. This finding was confirmed on multivariate analysis.…”

Section: Prognostic Factorsmentioning

confidence: 99%

A multicenter study of the prognosis and treatment of adult brain ependymal tumors

Reni

Brandes

Vavassori

et al. 2004

Cancer

107

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BACKGROUNDThe current analysis of outcomes in a large series of adult patients with intracranial ependymal tumors contributes to the characterization of the primary prognostic factors and to the therapeutic management of this rare disease, for which limited information is available in the literature.METHODSThe authors analyzed data on patient and tumor characteristics, treatment, and survival in a series of 70 patients age > 17 years with pathologic diagnoses of brain ependymal tumors from 4 institutions.RESULTSThe 5‐ and 10‐year overall survival (OS) rates (± standard errors) were 67% ± 6% and 50% ± 8%, respectively. The 5‐ and 10‐year failure‐free survival (FFS) rates were 43% ± 7% and 24% ± 6%, respectively. Younger age and infratentorial tumor location were associated with longer survival. Among patients with Grade 2 ependymoma (n = 51), 21 (41%) received no postsurgical treatment. These 21 patients had a 5‐year OS rate of 78% ± 10% and a 10‐year OS rate of 68% ± 13%; the 5‐ and 10‐year FFS rates for these patients were 47% ± 12% and 12% ± 11%, respectively. Twenty‐six patients with Grade 2 ependymoma (51%) received postoperative radiotherapy (RT). These 26 patients had a 5‐year OS rate of 71% ± 9% and a 10‐year OS rate of 59% ± 11%; the 5‐ and 10‐year FFS rates for these patients were 54% ± 10% and 34% ± 10%, respectively. Among patients with Grade 2 ependymoma, neither OS nor FFS differed significantly between those who did not receive postoperative RT and those who did; however, these two groups were heterogeneous with respect to prognostic factors. On multivariate analysis, RT use exhibited a trend toward improved OS and was significantly predictive of improved FFS.CONCLUSIONSThe current analysis does not rule out the possibility that deferral of RT at the time of recurrence could have a detrimental effect on FFS or OS in patients with Grade 2 ependymoma, regardless of the degree of ablation. The role of postoperative RT for patients who undergo imaging‐based macroscopic total resection remains to be addressed. Cancer 2004. © 2004 American Cancer Society.

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“…In children, ependymomas usually occur in the fourth ventricle and display a series of symptoms and signs, including increased intracranial pressure, ataxia, vertigo, chronic cerebellar tonsillar hernia and brainstem dysfunction (1,14). Despite the fact that infratentorial tumors exhibit a lower biological activity than supratentorial tumors (9,(15)(16)(17), tumors of the posterior fossa carry a higher surgical risk, due to the technical difficulties in performing a complete excision, which may lead to treatment failure (9,15).…”

Section: Introductionmentioning

confidence: 99%

Microsurgical management of pediatric ependymomas of the fourth ventricle via the trans-cerebellomedullary fissure approach: A review of 26 cases

Qiu

Wang

et al. 2016

Oncology Letters

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Abstract. In the present study, the microsurgical management of 26 ependymomas of the fourth ventricle in children via the trans-cerebellomedullary fissure (CMF) approach was reviewed and evaluated. Clinical data were obtained from 26 ependymomas of the fourth ventricle treated with microsurgery using the trans-CMF approach from March 2006 to September 2010 at the Department of Neurosurgery of The First Affiliated Hospital of China Medical University (Shenyang, China). These data were collected and analyzed. Suboccipital median posterior fossa craniotomy and trans-CMF approach were performed in all cases for the microsurgical removal of the tumors. An additional incision was performed in the inferior medullary velum of 5 patients, in order to obtain adequate exposure of the tumors. As a result, all tumors were well exposed during surgery. Gross total resection (GTR) was achieved in 22 cases, near total resection (NTR) in 3 cases and subtotal resection (STR) in 1 case. All excised tumors were pathologically confirmed. No mortality occurred intraoperatively, and no patient presented with mutism or any other surgery-related complications. One patient suffered from postoperative hydrocephalus and received ventriculoperitoneal shunting, which relieved the symptoms. Over the 3.0-7.5-year follow-up period (mean, 4.8 years), tumor relapse occurred in 1 case with GTR, 2 cases with NTR and 1 case with STR. In total, 3 patients succumbed to tumor relapse and 4 were lost to follow-up. According to the literature and the clinical experience of the present authors, the trans-CMF approach provides safe and sufficient access to the fourth ventricle without the requirement of an incision in the inferior vermis. This approach prevents damage to the normal cerebellum and improves the surgical outcome. Tumor removal, restoration of cerebrospinal fluid circulation and preservation of brainstem function are factors that should be taken into consideration during surgery. For patients with residual tumors, adjuvant radiotherapy and/or chemotherapy may be beneficial.

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Intracranial ependymomas in children

Cited by 171 publications

References 14 publications

The prognostic value of histological grading of posterior fossa ependymomas in children: a Children's Oncology Group study and a review of prognostic factors

The prognostic value of histological grading of posterior fossa ependymomas in children: a Children's Oncology Group study and a review of prognostic factors

A multicenter study of the prognosis and treatment of adult brain ependymal tumors

Microsurgical management of pediatric ependymomas of the fourth ventricle via the trans-cerebellomedullary fissure approach: A review of 26 cases

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