title: Infratentorial ependymomas: prognostic factors and outcome analysis in a multi-center retrospective series of 106 adult patients.
abstract: OBJECTIVE
  This study was undertaken to analyze outcomes and to assess the prognostic impact of age, location, surgery, radiotherapy (RT), and histopathology in a series of adult infratentorial ependymomas.
  
  
  METHODS
  This was a retrospective study of a population of 106 adult patients with infratentorial ependymomas diagnosed between 1990 and 2004. A central pathological review of all cases was performed. Grading was according to the WHO and Marseille's neograding classifications.
  
  
  RESULTS
  The series consisted of 58 males (54.7%) and 48 females (45.3%) in the age range of 18-82 years. Using the WHO classification, 88 patients (83.0%) had grade II and 18 patients (17.0%) grade III ependymomas. Using the Marseille's neograding system, 91 patients were low-grade and 15 high-grade. Gross total resection was achieved in 66 patients (62.3%). Thirty-seven patients (35.0%) received adjuvant RT. The 5- and 10-year overall survival rates for the entire cohort were 86.1% and 80.5%, respectively. On multivariate analysis, a preoperative Karnofski performance status score > 80, no recessus lateral extension and a low histological grade (Marseille's grading) were associated with a longer overall survival. The 5- and 10-year progression-free survival rates for the entire cohort were 70.8% and 57.7%, respectively. On multivariate analysis, no recessus lateral extension, gross total resection and a low histological grade (Marseille's grading) were associated with a longer progression-free survival. Adjuvant RT was significantly associated with a better overall and progression-free survival in incompletely resected WHO grade II ependymomas.
  
  
  CONCLUSIONS
  This study highlights the key role of histology in the clinical outcome and the fact that gross total resection is a main prognostic factor and the treatment of choice for posterior fossa ependymomas. The use of adjuvant RT in patients with incompletely resected WHO grade II ependymomas appears beneficial, but its effect on high-grade tumors remains to be determined.
authors.affiliation: Department of Neurosurgery, Pierre Wertheimer GHE Neurological Hospital, Lyon, France. jacques.guyotat@chu-lyon.fr
authors.forename: Jacques
authors.initials: J
authors.lastname: Guyotat
authors.forename: Philippe
authors.initials: P
authors.lastname: Metellus
authors.forename: Roch
authors.initials: R
authors.lastname: Giorgi
authors.forename: Marylin
authors.initials: M
authors.lastname: Barrie
authors.forename: Anne
authors.initials: A
authors.lastname: Jouvet
authors.forename: Michelle
authors.initials: M
authors.lastname: Fevre-Montange
authors.forename: Olivier
authors.initials: O
authors.lastname: Chinot
authors.forename: Anne
authors.initials: A
authors.lastname: Durand
authors.forename: Dominique
authors.initials: D
authors.lastname: Figarella-Branger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D001933:Brain Stem / Q000473:pathology / Q000528:radiation effects / Q000601:surgery*; D002531:Cerebellum / Q000473:pathology / Q000528:radiation effects / Q000601:surgery*; D004806:Ependymoma / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D006801:Humans; D015192:Infratentorial Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000517:prevention & control; D019635:Neurosurgical Procedures / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult