title: Long-term outcomes of surgical resection with or without adjuvant radiation therapy for treatment of spinal ependymoma: a retrospective multicenter study by the Korea Spinal Oncology Research Group.
abstract: BACKGROUND
  We sought to determine the surgical treatment and functional outcome and identify the predictors of survival in a retrospective cohort of patients with spinal cord ependymoma using data collected from the Korea Spinal Oncology Research Group database.
  
  
  METHODS
  The data regarding 88 patients who had been surgically treated for histologically confirmed spinal cord intramedullary and extramedullary ependymoma from January 1989 to December 2009 were retrospectively reviewed.
  
  
  RESULTS
  Histopathological examination revealed myxopapillary ependymoma in 24 patients, ependymoma in 61 patients, and anaplastic ependymoma in 3 patients. Gross total removal was achieved in 72 patients, subtotal removal in 15 patients, and partial removal in 1 patient. Twenty patients were treated with postoperative radiation. Fifty-two patients had stable or improved postoperative neurological function, while 36 experienced neurological deterioration. A permanent decrease in McCormick classification grade was seen in 17 patients. The progression-free survival rate was 87% for all patients at 5 years and 80% at 10 years. During follow-up, local recurrence/progression was seen in 13 patients. Diffuse meningeal spread developed in 2 anaplastic ependymoma patients. Postoperative radiotherapy after incomplete resection did not significantly correlate with longer times to recurrence. Multivariate analysis revealed histology and surgical extent of resection as independent predictors of longer progression-free survival.
  
  
  CONCLUSIONS
  Gross total removal alone is a good treatment strategy for spinal ependymomas. Early diagnosis and surgery, before severe paralysis, are important to obtain good functional outcomes. Subtotal resection with radiation therapy for intramedullary lesions appears to offer no advantages over gross total removal.
authors.affiliation: Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul 135-710, South Korea.
authors.forename: Sun-Ho
authors.initials: SH
authors.lastname: Lee
authors.forename: Chun Kee
authors.initials: CK
authors.lastname: Chung
authors.forename: Chi Heon
authors.initials: CH
authors.lastname: Kim
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Yoon
authors.forename: Seung-Jae
authors.initials: SJ
authors.lastname: Hyun
authors.forename: Ki-Jeong
authors.initials: KJ
authors.lastname: Kim
authors.forename: Eun-Sang
authors.initials: ES
authors.lastname: Kim
authors.forename: Whan
authors.initials: W
authors.lastname: Eoh
authors.forename: Hyun-Jib
authors.initials: HJ
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D018450:Disease Progression; D004806:Ependymoma / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery; D019635:Neurosurgical Procedures; D011379:Prognosis; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D013120:Spinal Cord Neoplasms / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery; D015996:Survival Rate; D013997:Time Factors; D055815:Young Adult
keywords: myxopapillary ependymoma; radiation; spinal ependymoma; survival