title: Ependymomas of the filum terminale: The role of surgery and radiotherapy.
abstract: BACKGROUND
  Ependymomas of the filum terminale (EFT) form a specific and relatively uncommon subtype of spinal cord ependymomas. Most series in the literature are small, spanning a large time period. Up to date no consensus has been reached about the optimal treatment of these lesions. Some authors promote postoperative radiotherapy for all cases, others advocate postoperative radiotherapy only when a subtotal resection is performed or when metastasis are apparent.
  
  
  METHODS
  We performed a retrospective analysis of 22 patients with an EFT (mean age at diagnosis of 35.6 years).
  
  
  RESULTS
  In all patients (9/22) with lesions smaller than 4.5 cm no metastases were present and a complete resection could be obtained. No adjuvant radiotherapy was performed and at latest follow they had an excellent outcome. In our series, these initial tumor characteristics were more important regarding prognosis than either histology or treatment-related factors. For the larger tumors, total resection was obtained less frequently, more dissemination was diagnosed and a worse outcome was scored. Radiotherapy if indicated did lead to an acceptable disease control.
  
  
  CONCLUSIONS
  In every case of EFT, an individual treatment protocol has to be outlined, but if an EFT is relatively small and can be resected completely, we would advocate to withhold radiotherapy.
authors.affiliation: Department of Neurosurgery, University Hospitals Leuven, Belgium.
authors.forename: Lars
authors.initials: L
authors.lastname: de Jong
authors.forename: Frank Van
authors.initials: FV
authors.lastname: Calenbergh
authors.forename: Johan
authors.initials: J
authors.lastname: Menten
authors.forename: Johannes
authors.initials: J
authors.lastname: van Loon
authors.forename: Steven
authors.initials: S
authors.lastname: De Vleeschouwer
authors.forename: Christiaan
authors.initials: C
authors.lastname: Plets
authors.forename: Mehrnaz
authors.initials: M
authors.lastname: Didgar
authors.forename: Raf
authors.initials: R
authors.lastname: Sciot
authors.forename: Jan
authors.initials: J
authors.lastname: Goffin