Postoperative radiation therapy for grade II and III intracranial ependymoma.
OBJECTIVE
To retrospectively determine the long-term outcome of intracranial ependymoma patients treated with surgery and postoperative radiation therapy.


METHODS
Sixty patients were treated at our institution between 1964 and 2000. Forty patients had World Health Organization Grade II ependymoma, and 20 patients had Grade III ependymoma. The median patient age was 10.7 years. The majority of patients were male (55%), had infratentorial tumors (80%), and had subtotal resections (72%). Postoperative radiation therapy was delivered to all patients to a median total dose of 50.4 Gy. Craniospinal radiation therapy was used in the earlier era in only 12 patients (20%).


RESULTS
The median follow-up of surviving patients was 12.5 years. The 5-year and 10-year disease-free survival rates for all patients were 58.4% and 49.5%, respectively. The 5-year and 10-year overall survival rates for all patients were 71.2% and 55.0%, respectively. Supratentorial tumor location was independently associated with a worse disease-free survival. Subtotal resection and supratentorial location predicted a worse overall survival, but this failed to reach statistical significance. No statistically significant effect on prognosis was observed with tumor grade, patient age, or radiation dose or volume.


CONCLUSIONS
Our long-term follow-up indicates that half of ependymoma patients will have disease recurrences, indicating the need for more effective treatments.
Mansur
David B
DB
Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO 63110, USA. mansur@radonc.wustl.edu
Perry
Arie
A
Rajaram
Veena
V
Michalski
Jeff M
JM
Park
T S
TS
Leonard
Jeffrey R
JR
Luchtman-Jones
Lori
L
Rich
Keith M
KM
Grigsby
Perry W
PW
Lockett
Mary Ann
MA
Wahab
Sasha H
SH
Simpson
Joseph R
JR
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D004806:Ependymoma / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D015192:Infratentorial Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D015173:Supratentorial Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D015996:Survival Rate