title: Ependymoma in adults: surgery, reoperation and radiotherapy for survival.
abstract: OBJECTIVE
  to retrospectively determine the long-term outcome of adult intracranial ependymoma patients treated with surgery, reoperation, and postoperative radiation therapy.
  
  
  METHODS
  61 patients were treated at our institution between 1980 and 2004. Forty patients had World Health Organization (WHO) Grade II ependymoma, and 21 patients had Grade III ependymoma. The median age was 34 years. The majority of patients were female (59%), and 35 had gross total resections (60%). Eighteen patients were reoperated, 15 only once but 2 twice and one six times. Survival times following reoperation was mostly short but some of them reached more than 5 or 10 years. Postoperative radiation therapy was delivered to 31 patients postoperative (55.4%) and to 5 after reoperation, a median total dose of 54 Gy.
  
  
  RESULTS
  The median follow-up of surviving patients was 10.6 years. The 5-year and 10-year disease free survival rates for all patients were 50% and 32.9% respectively. The 5-year and 10-year overall survival rates for all patients were 57.1% and 39.4%, respectively. A statistically significant effect on prognosis was observed with WHO tumour grade as well as with MIB-1 labelling index. Subtotal resection predicted a worse overall survival, but this failed to reach statistical significance. No statistically significant effect on prognosis was observed with tumour location and radiation therapy.
  
  
  CONCLUSIONS
  In our experience the use of radiotherapy in adult, intracranial WHO Grade II ependymoma patients had no significant effect on prognosis. Radical surgery and eventual reoperation seems to be more favorable.
authors.affiliation: National Institute of Neurosurgery, Amerikai ut 57., 1145, Budapest, Hungary.
authors.forename: Dusan
authors.initials: D
authors.lastname: Vitanovics
authors.forename: Katalin
authors.initials: K
authors.lastname: Bálint
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Hanzély
authors.forename: Péter
authors.initials: P
authors.lastname: Banczerowski
authors.forename: Dénes
authors.initials: D
authors.lastname: Afra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality* / Q000628:therapy*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004806:Ependymoma / Q000401:mortality* / Q000628:therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011878:Radiotherapy; D012086:Reoperation; D012189:Retrospective Studies; D055815:Young Adult