title: Combined treatment of fourth ventricle ependymomas: report of 26 cases.
abstract: BACKGROUND
  This study investigated the relevance of prognostic factors and the impact of histological features in posterior fossa ependymoma.
  
  
  METHODS
  The charts of 26 patients (aged 1-59 years, mean 20.6 years; 11 adults) with posterior fossa ependymoma operated on between January 1983 and December 1994 were reviewed and patients followed up (mean: 93 months).
  
  
  RESULTS
  Gross total resection was performed in 18 patients (69%), subtotal in seven patients (27%), biopsy in one patient (4%). One patient (3.8%) developed respiratory complications and died. All patients underwent posterior fossa radiotherapy (5000 cGy) after surgery. Four children first received chemotherapy and then radiotherapy only when at least 3 years old. Eleven patients (42%) received radiotherapy and subsequently chemotherapy. The 5-year survival rate was 90% for adults and 40% for children (</= 6 years).
  
  
  CONCLUSIONS
  This review suggests that a) younger patients (</= 6 years), despite multimodality treatment, have a poor prognosis; b) the microanatomical location of the tumor (lateral recess, roof, and floor) influences the extent of tumor removal (p < 0.05); c) longer survivals are associated with complete removal (p < 0.05); d) the histological feature most often related to a poor prognosis is a high mitotic index (p < 0.05), whereas vascular proliferation (p = 0.149), necrosis (p = 0.215), nuclear atypia (p = 0.384) and high cellularity (p = 0.786) do not affect survival; e) histological classification (WHO) does not reflect different survival rates between ependymomas and anaplastic ependymomas (p = 0.082).
authors.affiliation: Institute of Neurosurgery, University of Milan, Ospedale Maggiore Policlinico I.R.C.C.S., Milan, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Spagnoli
authors.forename: G
authors.initials: G
authors.lastname: Tomei
authors.forename: G
authors.initials: G
authors.lastname: Ceccarelli
authors.forename: N
authors.initials: N
authors.lastname: Grimoldi
authors.forename: A
authors.initials: A
authors.lastname: Lanterna
authors.forename: L
authors.initials: L
authors.lastname: Bello
authors.forename: M M
authors.initials: MM
authors.lastname: Sinisi
authors.forename: A
authors.initials: A
authors.lastname: De Santis
authors.forename: R M
authors.initials: RM
authors.lastname: Villani
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003388:Cranial Fossa, Posterior / Q000528:radiation effects / Q000601:surgery; D004806:Ependymoma / Q000401:mortality / Q000473:pathology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D020546:Fourth Ventricle / Q000528:radiation effects / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome