Treatment of spinal cord ependymomas by surgery with or without postoperative radiotherapy.
OBJECTIVE
To evaluate the effectiveness of complete resection and postoperative radiotherapy in spinal cord ependymomas.


METHODS
We conducted a retrospective study over 20 patients (13 males and 7 females) with histologically confirmed spinal cord ependymomas between July 1985 and April 2001. Among them, 13 patients had ependymomas, 6 had myxopapillary ependymomas, and 1 had anaplastic ependymoma. All patients received radical surgery for tumor removal with 13 patients achieving complete resection and 7 incomplete resection due to technical difficulty. Among those with incomplete resection, 6 patients received postoperative radiotherapy to tumor bed and only one patient with anaplastic ependymoma received surgery alone. The total tumor dose ranged from 50 to 60 Gy.


RESULTS
Among the 20 patients, 19 patients were alive and showed local control. The median survival time of all patients was 109 months, with 104 months in the complete resection alone group and 135 months in the incomplete resection with postoperative radiotherapy group. One patient with anaplastic ependymoma and no postoperative radiotherapy developed leptomeningeal seeding 9 months after surgery. Salvage therapy of radiotherapy and chemotherapy maintained normal neurological functions. The patient expired 34 months from the initial diagnosis due to progression of leptomeningeal seeding.


CONCLUSIONS
Complete resection alone in spinal cord ependymoma can achieve excellent local control and survival. Patients should receive complete resection if technically possible. Postoperative radiotherapy is not recommended for complete resection. For incomplete resection, postoperative local radiotherapy is recommended and it can also achieve excellent local control and survival. Local radiotherapy with 50-60 Gy is effective and safe. Salvage radiotherapy improves quality of life for local recurrence or leptomeningeal seeding patients.
Lin
Yi-Hsien
YH
Cancer Center, Taipei Veterans General Hospital, 201, Sec. 2., Shih-Pau Road, 1217, Taipei, Taiwan.
Huang
Chun-I
CI
Wong
Tai-Ton
TT
Chen
Min-Hsiung
MH
Shiau
Cheng-Ying
CY
Wang
Ling-Wei
LW
Ming-Tak Ho
Donald
D
Yen
Sang-Hue
SH
D000328:Adult; D000368:Aged; D002648:Child; D003131:Combined Modality Therapy; D004806:Ependymoma / Q000503:physiopathology / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000628:therapy; D009420:Nervous System / Q000503:physiopathology; D012189:Retrospective Studies; D016879:Salvage Therapy; D013120:Spinal Cord Neoplasms / Q000503:physiopathology / Q000532:radiotherapy* / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome