[Factors influencing recurrence and role of radiotherapy in filum terminale ependymomas. 14 cases and review of the literature].
OBJECTIVE
We reviewed a series of 14 cases of filum terminale ependymoma and 264 cases in the literature, to study the characteristics of these tumors and specifically to determine factors influencing recurrence.


METHODS
This series analyzed data between 1984 and 1998. The mean follow-up period was 5.5 years and the median age 40 years. Pain was the first symptom, except in one case, with progressive sensitive-motor deficit. Four patients had a myelography and a CT scan, and ten a MRI. All patients were operated with a total resection in 12 cases. All tumors, except one, were a myxopapillary ependymoma.


RESULTS
Clinical results were excellent in 2 cases, good in 8, stable in 2 and worse in 2. Two patients had a recurrence after an initial sub-total resection, both were operated on again, followed by post-operative radiotherapy. Among the 278 filum terminale ependymoma, removal was total in 200 (72%). A recurrence occurred in 15% of them after total removal, and in 43% after partial removal (p<0.001). Among patients with partial removal, recurrence was observed in 33% of them if they had post-operative radiotherapy, and in 55% of them if they did not have post-operative radiotherapy (p<0.05).


CONCLUSIONS
The extent of tumor removal has a statistically significant effect upon recurrence. This review is in favor of post-operative radiotherapy in case of partial removal, but this systematic attitude can be discussed after a critical analysis of this study. Long term follow-up is mandatory due to the possibility of late recurrence.
Lonjon
M
M
Service de Neurochirurgie, Hôpital Pasteur, CHU de Nice-UNSA, 30, avenue de la Voie-Romaine, BP 69, 06000 Nice. lonjon.m@chu-nice.fr
Von Langsdorf
D
D
Lefloch
S
S
Rahbi
M
M
Rasendrarijao
D
D
Michiels
J F
JF
Paquis
P
P
Grellier
P
P
D000328:Adult; D000368:Aged; D002420:Cauda Equina; D003131:Combined Modality Therapy; D018450:Disease Progression; D004806:Ependymoma / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010524:Peripheral Nervous System Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome