The results of surgery, with or without radiotherapy, for primary spinal myxopapillary ependymoma: a retrospective study from the rare cancer network

Int J Radiat Oncol Biol Phys. 2009 Jul 15;74(4):1114-20. doi: 10.1016/j.ijrobp.2008.09.034. Epub 2009 Feb 26.

Abstract

Purpose: The aim of this study was to assess the outcome of patients with primary spinal myxopapillary ependymoma (MPE).

Materials and methods: Data from a series of 85 (35 females, 50 males) patients with spinal MPE were collected in this retrospective multicenter study. Thirty-eight (45%) underwent surgery only and 47 (55%) received postoperative radiotherapy (RT). Median administered radiation dose was 50.4 Gy (range, 22.2-59.4). Median follow-up of the surviving patients was 60.0 months (range, 0.2-316.6).

Results: The 5-year progression-free survival (PFS) was 50.4% and 74.8% for surgery only and surgery with postoperative low- (<50.4 Gy) or high-dose (>or=50.4 Gy) RT, respectively. Treatment failure was observed in 24 (28%) patients. Fifteen patients presented treatment failure at the primary site only, whereas 2 and 1 patients presented with brain and distant spinal failure only. Three and 2 patients with local failure presented with concomitant spinal distant seeding and brain failure, respectively. One patient failed simultaneously in the brain and spine. Age greater than 36 years (p = 0.01), absence of neurologic symptoms at diagnosis (p = 0.01), tumor size >or=25 mm (p = 0.04), and postoperative high-dose RT (p = 0.05) were variables predictive of improved PFS on univariate analysis. In multivariate analysis, only postoperative high-dose RT was independent predictors of PFS (p = 0.04).

Conclusions: The observed pattern of failure was mainly local, but one fifth of the patients presented with a concomitant spinal or brain component. Postoperative high-dose RT appears to significantly reduce the rate of tumor progression.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Analysis of Variance
  • Brain Neoplasms / secondary
  • Child
  • Combined Modality Therapy / methods
  • Disease Progression
  • Disease-Free Survival
  • Ependymoma / mortality
  • Ependymoma / radiotherapy*
  • Ependymoma / secondary
  • Ependymoma / surgery*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local
  • Radiotherapy / adverse effects
  • Radiotherapy Dosage
  • Retrospective Studies
  • Spinal Neoplasms / mortality
  • Spinal Neoplasms / radiotherapy*
  • Spinal Neoplasms / surgery*
  • Treatment Failure
  • Young Adult