The role of adjuvant radiation therapy in the treatment of spinal myxopapillary ependymomas

Chao, Samuel T.; Kobayashi, Taisei; Benzel, Edward C.; Reddy, Chandana A.; Stevens, Glen; Prayson, Richard A.; Kalfas, Iain H.; Schlenk, Richard; Krishnaney, Ajit A.; Steinmetz, Michael P.; Bingaman, William; Hahn, Joseph F.; Suh, John H.

doi:10.3171/2010.9.spine09920

Cited by 47 publications

(27 citation statements)

References 9 publications

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“…7,33,57,62,67,70,74,80,87,93,117,118,129,133,139 However, Akyurek and colleagues 4 reported that in 35 cases of myxopapillary ependymomas, postoperative radiotherapy was able to decrease the rate of tumor progression, regardless of the extent of resection. In addition, Chao and colleagues 21 demonstrated that at the time of initial recurrence, radiation may be able to prolong the interval until subsequent recurrences. Given the rate of recurrence for spinal ependymomas treated with surgery alone and the success of radiation as a potential salvage therapy, Al-Halabi and colleagues 5 recommended that postoperative serial imaging be mandatory.…”

Section: Radiotherapymentioning

confidence: 99%

Complications associated with the treatment for spinal ependymomas

Nagasawa

Smith

Cremer

et al. 2011

FOC

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Spinal cord ependymomas are rare neoplasms, comprising approximately 5% of all CNS tumors and 15% of all spinal cord tumors. Although surgery was once reserved for diagnosis alone, the evolution of surgical practices has elevated resection to the treatment of choice for these lesions. While technological advances continue to improve the capacity for gross-total resections and thus decrease the risk of recurrence, ependymoma spinal surgery still contains a variety of potential complications. The presence of neurological deficits and deterioration are not uncommonly associated with spinal cord ependymoma surgery, including sensory loss, dorsal column dysfunction, dysesthetic syndrome, and bowel and bladder dysfunction, particularly in the immediate postoperative period. Surgical treatment may also lead to wound complications and CSF leaks, with increased risk when radiotherapy has been involved. Radiation therapy may also predispose patients to radiation myelopathy and ultimately result in neurological damage. Additionally, resections of spinal ependymomas have been associated with postoperative spinal instability and deformities, particularly in the pediatric population. Despite the advances in microsurgical techniques and intraoperative cord monitoring modalities, there remain a number of serious complications related to the treatment of spinal ependymoma tumors. Identification and acknowledgment of these potential problems may assist in their prevention, early detection, and increased quality of life for patients afflicted with this disease.

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Section: Radiotherapymentioning

confidence: 99%

Complications associated with the treatment for spinal ependymomas

Nagasawa

Smith

Cremer

et al. 2011

FOC

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“…Bagley and colleagues 7 and Chao and colleagues 11 demonstrated no benefit in recurrence-free survival for patients treated with adjuvant radiotherapy after surgery. Akyurek and colleagues, 2 on the other hand, found that adjuvant radiotherapy was associated with better outcomes for both patients who underwent GTR and those who underwent STR.…”

Section: ©Aans 2013mentioning

confidence: 99%

“…1,6,16,23,[27][28][29]32 In total, 28 articles with 475 patients were included in this integrative analysis. [2][3][4][5][7][8][9][10][11][12][13][14][15][17][18][19][20][21][23][24][25][26]30,31,[34][35][36][37] …”

Section: Article Selectionmentioning

confidence: 99%

Tumor control after surgery for spinal myxopapillary ependymomas: distinct outcomes in adults versus children

Feldman

Clark²,

Safaee³

et al. 2013

SPI

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Object Myxopapillary ependymomas (MPEs) are rare WHO Grade I tumors found in the conus medullaris, cauda equina, and filum terminale. Treatment generally consists of resection with or without adjuvant radiotherapy. Evidence-based guidelines for surgical management are lacking due to the rarity of this tumor. Methods An English-language PubMed search was performed using the key words “myxopapillary” and “ependymoma.” Reports describing fewer than 3 patients or those lacking data on the extent of resection or radiotherapy were excluded. A total of 28 articles describing 475 patients met the authors' inclusion criteria. Patients were grouped by extent of resection and whether or not they underwent adjuvant radiotherapy. Differences in recurrence rates were assessed by chi-square test. Results The overall recurrence rate was 15.5% in patients treated by gross-total resection (GTR) and 32.6% in patients treated by subtotal resection (STR), irrespective of whether they underwent adjuvant therapy (p < 0.001). Regardless of the extent of resection, adjuvant radiotherapy was not associated with a decrease in recurrence rates. The overall recurrence rate was 15.6% in patients who underwent GTR and radiotherapy compared with 15.9% in patients who underwent GTR alone (p = 0.58), and it was 29.3% in patients who underwent STR and radiotherapy compared with 35.1% in those who underwent STR alone (p = 0.53). The difference between recurrence rates for patients who underwent GTR alone versus STR and radiotherapy was statistically significant (p = 0.02). Subgroup analysis demonstrated significantly higher recurrence rates in pediatric patients compared with adults (40.5% vs 23.4%, respectively; p = 0.02). Even in the setting of GTR alone, recurrence rates were higher in pediatric patients (65% vs 7.6%; p < 0.001). Conclusions Gross-total resection alone is associated with decreased recurrence rates compared with STR with or without radiotherapy. The authors' results suggest that treatment goals should include attempted GTR whenever possible. The observation that children benefitted from radiation therapy to a greater extent than did adults suggests that biological differences between tumors in these patient populations warrants more rigorous scientific studies.

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“…An association between GTR and increased OS and PFS in cases of spinal ependymoma has been well documented in the adult literature and in a handful of pediatric studies; however, few studies provide analysis stratified by grade. 11,12,14,16,17,59,62 Safaee et al reported that among 43 Grade II ependymomas, GTR was associated with increased PFS. 59 Benesch et al (n = 29) did not find a statistically significant relationship between extent of resection and OS; however, they found that GTR trended toward an association with increased PFS (p = 0.088).…”

Section: Surgery and Adjuvant Radiation Therapymentioning

confidence: 99%

Treatment of pediatric Grade II spinal ependymomas: a population-based study

Lin

Jea

Melkonian

et al. 2015

PED

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OBJECT Grade II spinal cord ependymomas occurring in pediatric patients are exceptionally rare neoplasms. In this paper the authors use a national cancer database to determine patient demographics, treatment patterns, and associated outcomes of this cohort. METHODS The Surveillance Epidemiology and End Results (SEER) database was used to analyze subjects younger than 18 years with histologically confirmed diagnoses of Grade II spinal cord ependymoma from the years 1973 to 2008. Descriptive data on the demographic characteristics of this cohort and the associated treatment patterns are shown. The Kaplan-Meier method was used to estimate overall survival at 1, 2, 5, and 10 years. RESULTS This cohort comprised 64 pediatric subjects with Grade II spinal ependymoma. The median age was 13 years, nearly half of the patients were male, and most were white (84%). The median follow-up was 9.2 years. Overall survival at 5 and 10 years was 86% and 83%, respectively. Gross-total resection was achieved in 57% of subjects, and radiation therapy was administered to 36%. Radiation therapy was administered to 78% of subjects after subtotal resection but only to 19% of patients after gross-total resection; this difference was significant (p < 0.001). In a multivariate regression model analyzing sex, age at diagnosis, year of diagnosis, radiotherapy, and extent of resection, female sex was found to be an independent predictor of decreased mortality (HR 0.15 [95% CI 0.02–0.94], p = 0.04). CONCLUSIONS These data show long-term outcomes for pediatric patients with Grade II spinal ependymoma. Radiotherapy was more likely to be administered in cases of subtotal resection than in cases of gross-total resection. Female sex is associated with decreased mortality, while other demographic or treatment modalities are not.

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The role of adjuvant radiation therapy in the treatment of spinal myxopapillary ependymomas

Cited by 47 publications

References 9 publications

Complications associated with the treatment for spinal ependymomas

Complications associated with the treatment for spinal ependymomas

Tumor control after surgery for spinal myxopapillary ependymomas: distinct outcomes in adults versus children

Treatment of pediatric Grade II spinal ependymomas: a population-based study

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