title: Ependymoma: results, prognostic factors and treatment recommendations.
abstract: OBJECTIVE
  To review the University of Florida experience in treating ependymomas, analyze prognostic factors, and provide treatment recommendations.
  
  
  METHODS
  Forty-one patients with ependymoma and no metastases outside the central nervous system received postoperative radiotherapy with curative intent between 1966 and 1989. Ten patients had supratentorial lesions, 22 had infratentorial lesions, and 9 had spinal cord lesions. All patients had surgery (stereotactic biopsy, subtotal resection, or gross total resection). Most patients with high-grade lesions received radiotherapy to the craniospinal axis. Low-grade intracranial lesions received more limited treatment. Spinal cord lesions were treated using either partial spine or whole spine fields.
  
  
  RESULTS
  Of 32 intracranial tumors, 21 recurred, all at the primary site; no spinal cord tumors recurred. Overall 10-year survival rates were 51% (absolute) and 46% (relapse-free); by tumor site: spinal cord, 100%; infratentorial, 45%; supratentorial, 20% (p = 0.002). On multivariate analysis, tumor site was the only factor that influenced absolute survival (p = 0.0004); other factors evaluated included grade, gender, age, duration of symptoms, resection extent, primary tumor dose, treatment field extent, surgery-to-radiotherapy interval, and days under radiotherapy treatment.
  
  
  CONCLUSIONS
  Patients with supratentorial or infratentorial tumors receive irradiation, regardless of grade. Craniospinal-axis fields are used when spinal seeding is radiographically or pathologically evident. Spinal cord tumors are treated using localized fields to the primary site if not completely resected. Failure to control disease at the primary site remains the main impediment to cure.
authors.affiliation: Department of Radiation Oncology, University of Florida College of Medicine, Gainesville 32610-0385, USA.
authors.forename: M P
authors.initials: MP
authors.lastname: McLaughlin
authors.forename: R B
authors.initials: RB
authors.lastname: Marcus
authors.forename: J M
authors.initials: JM
authors.lastname: Buatti
authors.forename: W M
authors.initials: WM
authors.lastname: McCollough
authors.forename: J P
authors.initials: JP
authors.lastname: Mickle
authors.forename: A
authors.initials: A
authors.lastname: Kedar
authors.forename: B L
authors.initials: BL
authors.lastname: Maria
authors.forename: R R
authors.initials: RR
authors.lastname: Million
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D002648:Child; D004806:Ependymoma / Q000401:mortality / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D015192:Infratentorial Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D008297:Male; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D011878:Radiotherapy / Q000009:adverse effects; D013120:Spinal Cord Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D015173:Supratentorial Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D015996:Survival Rate