Long-term outcome after resection of intraspinal ependymomas: report of 86 consecutive cases.
BACKGROUND



OBJECTIVE
To evaluate progression-free survival, overall survival (OS) and long-term clinical outcome in a consecutive series of 86 patients with intraspinal ependymomas.


METHODS
Medical charts were retrospectively reviewed. Surviving patients voluntarily participated in a clinical history and physical examination that focused on neurological function and current tumor status.


RESULTS
Follow-up data are nearly 100% complete; mean follow-up time was 82 months. Eighty-five patients (99%) had surgery as a first-line treatment; 14 (17%) of these patients received adjuvant radiotherapy. Of the 85 patients who underwent primary surgery, gross total resection was performed in 60 patients (71%) and subtotal resection in 25 patients (29%). Ten-year progression-free survival rate was 75%; 5-year OS, 97%; and 10-year OS, 91%. Reduced preoperative neurological function and older age at diagnosis were significantly associated with increased risk of death. At follow-up, spontaneous regression of residual tumor after primary surgery may have occurred in 7 of 19 patients (37%). More than 75% of patients had neurological function compatible with an independent life at follow-up. Good preoperative neurological function was significantly associated with favorable outcome. It was not possible to evaluate the effect of radiotherapy on progression-free survival and OS.


CONCLUSIONS
Gross total resection remains the optimal treatment for patients with spinal ependymoma. Patients should be monitored with a clinical examination and magnetic resonance imaging at regular intervals up to 10 years after surgery.
Faculty of Medicine, University of Oslo, and Department of Neurosurgery, Oslo University Hospital, Ullevål, Oslo, Norway. charlmha@ulrik.uio.no
Charlotte Marie
CM
Halvorsen
Frode
F
Kolstad
John
J
Hald
Tom Børge
TB
Johannesen
Bård Kronen
BK
Krossnes
Iver A
IA
Langmoen
Bjarne
B
Lied
Pål
P
Rønning
Sigrun
S
Skaar
Signe
S
Spetalen
Eirik
E
Helseth
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D018572:Disease-Free Survival; D004806:Ependymoma / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000532:radiotherapy / Q000601:surgery; D009460:Neurologic Examination; D009493:Neurosurgery / Q000379:methods*; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult