title: The role of adjuvant radiation therapy in the treatment of spinal myxopapillary ependymomas.
abstract: OBJECTIVE
  the goal in this study was to determine the role of radiation therapy (RT) in the treatment of spinal myxopapillary ependymomas (MPEs).
  
  
  METHODS
  thirty-seven patients with histologically verified spinal MPEs were reviewed. Kaplan-Meier analyses and Cox proportional hazard regression were used to determine what patient and treatment factors influenced overall survival (OS) and recurrence.
  
  
  RESULTS
  at the time of initial diagnosis, the median age was 33 years and the Karnofsky Performance Scale score was 80. In 86.5% of cases, the most common presenting symptom was pain. All patients received surgery as their initial treatment. Nine patients also received RT along with surgery, with a median total dose of 50.2 Gy. The mean survival time was 12.2 years; however, only 4 of 37 patients had died at the time of this study. None of the patient or treatment parameters significantly correlated with OS. Sixteen patients (43.2%) were found to have a recurrence, with a median time to recurrence of 7.7 years. None of the patient or treatment parameters correlated with recurrence-free survival for an initial recurrence. The median time to the second recurrence (recurrence following therapy for initial recurrence) was 1.6 years. Use of RT as salvage therapy after initial recurrence significantly correlated with longer times to a second recurrence. The median recurrence-free survival time before the second recurrence was 9.6 years for those who received RT versus 1.1 years for those who did not receive RT (p = 0.0093). None of the other parameters significantly correlated with a second recurrence.
  
  
  CONCLUSIONS
  radiation therapy may have a role as salvage therapy in delaying recurrences of spinal MPEs.
authors.affiliation: Department of Radiation Oncology/Brain Tumor and Neuro-Oncology Center, Cleveland, Ohio 44195, USA. chaos@ccf.org
authors.forename: Samuel T
authors.initials: ST
authors.lastname: Chao
authors.forename: Taisei
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Edward
authors.initials: E
authors.lastname: Benzel
authors.forename: Chandana A
authors.initials: CA
authors.lastname: Reddy
authors.forename: Glen H J
authors.initials: GH
authors.lastname: Stevens
authors.forename: Richard A
authors.initials: RA
authors.lastname: Prayson
authors.forename: Iain
authors.initials: I
authors.lastname: Kalfas
authors.forename: Richard
authors.initials: R
authors.lastname: Schlenk
authors.forename: Ajit
authors.initials: A
authors.lastname: Krishnaney
authors.forename: Michael P
authors.initials: MP
authors.lastname: Steinmetz
authors.forename: William
authors.initials: W
authors.lastname: Bingaman
authors.forename: Joseph
authors.initials: J
authors.lastname: Hahn
authors.forename: John H
authors.initials: JH
authors.lastname: Suh
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D004806:Ependymoma / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D016016:Proportional Hazards Models; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D016879:Salvage Therapy; D013120:Spinal Cord Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery