title: The results of surgery, with or without radiotherapy, for primary spinal myxopapillary ependymoma: a retrospective study from the rare cancer network.
abstract: OBJECTIVE
  The aim of this study was to assess the outcome of patients with primary spinal myxopapillary ependymoma (MPE).
  
  
  METHODS
  Data from a series of 85 (35 females, 50 males) patients with spinal MPE were collected in this retrospective multicenter study. Thirty-eight (45%) underwent surgery only and 47 (55%) received postoperative radiotherapy (RT). Median administered radiation dose was 50.4 Gy (range, 22.2-59.4). Median follow-up of the surviving patients was 60.0 months (range, 0.2-316.6).
  
  
  RESULTS
  The 5-year progression-free survival (PFS) was 50.4% and 74.8% for surgery only and surgery with postoperative low- (<50.4 Gy) or high-dose (>or=50.4 Gy) RT, respectively. Treatment failure was observed in 24 (28%) patients. Fifteen patients presented treatment failure at the primary site only, whereas 2 and 1 patients presented with brain and distant spinal failure only. Three and 2 patients with local failure presented with concomitant spinal distant seeding and brain failure, respectively. One patient failed simultaneously in the brain and spine. Age greater than 36 years (p = 0.01), absence of neurologic symptoms at diagnosis (p = 0.01), tumor size >or=25 mm (p = 0.04), and postoperative high-dose RT (p = 0.05) were variables predictive of improved PFS on univariate analysis. In multivariate analysis, only postoperative high-dose RT was independent predictors of PFS (p = 0.04).
  
  
  CONCLUSIONS
  The observed pattern of failure was mainly local, but one fifth of the patients presented with a concomitant spinal or brain component. Postoperative high-dose RT appears to significantly reduce the rate of tumor progression.
authors.affiliation: Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Alessia
authors.initials: A
authors.lastname: Pica
authors.forename: Robert
authors.initials: R
authors.lastname: Miller
authors.forename: Salvador
authors.initials: S
authors.lastname: Villà
authors.forename: Sidney P
authors.initials: SP
authors.lastname: Kadish
authors.forename: Yavuz
authors.initials: Y
authors.lastname: Anacak
authors.forename: Huda
authors.initials: H
authors.lastname: Abusaris
authors.forename: Gokhan
authors.initials: G
authors.lastname: Ozyigit
authors.forename: Brigitta G
authors.initials: BG
authors.lastname: Baumert
authors.forename: Renata
authors.initials: R
authors.lastname: Zaucha
authors.forename: Guy
authors.initials: G
authors.lastname: Haller
authors.forename: Damien C
authors.initials: DC
authors.lastname: Weber
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001932:Brain Neoplasms / Q000556:secondary; D002648:Child; D003131:Combined Modality Therapy / Q000379:methods; D018450:Disease Progression; D018572:Disease-Free Survival; D004806:Ependymoma / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011878:Radiotherapy / Q000009:adverse effects; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D017211:Treatment Failure; D055815:Young Adult