TY - JOUR
T1 - Outcomes after surgery and radiotherapy for spinal myxopapillary ependymoma
T2 - Update of the MD anderson cancer center experience
AU - Tsai, Chiaojung Jillian
AU - Wang, Yucai
AU - Allen, Pamela K.
AU - Mahajan, Anita
AU - Mccutcheon, Ian E.
AU - Rao, Ganesh
AU - Rhines, Laurence D.
AU - Tatsui, Claudio E.
AU - Armstrong, Terri S.
AU - Maor, Moshe H.
AU - Chang, Eric L.
AU - Brown, Paul D.
AU - Li, Jing
PY - 2014/9
Y1 - 2014/9
N2 - BACKGROUND:: The role of radiotherapy after surgery for myxopapillary ependymoma (MPE) is unclear. OBJECTIVE:: To review long-term outcomes after surgery, with or without radiation, for spinal MPE. METHODS:: Fifty-one patients with spinal MPE treated from 1968 to 2007 were included. Associations between clinical variables and overall survival (OS), progression-free survival (PFS), and local control (LC) were tested with Cox regression analysis. RESULTS:: The median age at diagnosis was 35 years (range, 8-63 years). Twenty patients (39%) had surgery alone, 30 (59%) had surgery plus radiotherapy (RT), and 1 (2%) had RT only. At a median follow-up of 11 years (range, 0.2-37 years), 10-year OS, PFS, and LC for the entire group were 93%, 63%, and 67%, respectively. Nineteen patients (37%) had disease recurrence, and the recurrence was mostly local (79%). Twenty-eight of 50 patients who had surgery (56%) had gross total resection; 10-year LC was 56% after surgery vs 92% after surgery and RT (log-rank P = .14); the median time of LC was 10.5 years for patients receiving gross total resection plus RT, and 4.75 years for gross total resection only (P = .03). Among 16 patients with subtotal resection and follow-up data, 10-year LC was 0% after surgery vs 65% for surgery plus RT (log-rank P = .008). On multivariate analyses adjusting for resection type, age older that 35 years at diagnosis and receipt of adjuvant radiation were associated with improved PFS (hazard ratio [HR]: 0.14, P = .003 and HR: 0.45, P = .009) and LC (HR: 0.22, P = .02 and HR: 0.45, P = .009). CONCLUSION:: Postoperative radiotherapy after resection of MPE was associated with improved PFS and LC.
AB - BACKGROUND:: The role of radiotherapy after surgery for myxopapillary ependymoma (MPE) is unclear. OBJECTIVE:: To review long-term outcomes after surgery, with or without radiation, for spinal MPE. METHODS:: Fifty-one patients with spinal MPE treated from 1968 to 2007 were included. Associations between clinical variables and overall survival (OS), progression-free survival (PFS), and local control (LC) were tested with Cox regression analysis. RESULTS:: The median age at diagnosis was 35 years (range, 8-63 years). Twenty patients (39%) had surgery alone, 30 (59%) had surgery plus radiotherapy (RT), and 1 (2%) had RT only. At a median follow-up of 11 years (range, 0.2-37 years), 10-year OS, PFS, and LC for the entire group were 93%, 63%, and 67%, respectively. Nineteen patients (37%) had disease recurrence, and the recurrence was mostly local (79%). Twenty-eight of 50 patients who had surgery (56%) had gross total resection; 10-year LC was 56% after surgery vs 92% after surgery and RT (log-rank P = .14); the median time of LC was 10.5 years for patients receiving gross total resection plus RT, and 4.75 years for gross total resection only (P = .03). Among 16 patients with subtotal resection and follow-up data, 10-year LC was 0% after surgery vs 65% for surgery plus RT (log-rank P = .008). On multivariate analyses adjusting for resection type, age older that 35 years at diagnosis and receipt of adjuvant radiation were associated with improved PFS (hazard ratio [HR]: 0.14, P = .003 and HR: 0.45, P = .009) and LC (HR: 0.22, P = .02 and HR: 0.45, P = .009). CONCLUSION:: Postoperative radiotherapy after resection of MPE was associated with improved PFS and LC.
KW - Radiation
KW - Spinal myxopapillary ependymoma
KW - Surgery
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U2 - 10.1227/NEU.0000000000000408
DO - 10.1227/NEU.0000000000000408
M3 - Review article
C2 - 24818785
AN - SCOPUS:84908356454
SN - 0148-396X
VL - 75
SP - 205
EP - 214
JO - Neurosurgery
JF - Neurosurgery
IS - 3
ER -