title: Outcomes after surgery and radiotherapy for spinal myxopapillary ependymoma: update of the MD Anderson Cancer Center experience.
abstract: BACKGROUND
  The role of radiotherapy after surgery for myxopapillary ependymoma (MPE) is unclear.
  
  
  OBJECTIVE
  To review long-term outcomes after surgery, with or without radiation, for spinal MPE.
  
  
  METHODS
  Fifty-one patients with spinal MPE treated from 1968 to 2007 were included. Associations between clinical variables and overall survival (OS), progression-free survival (PFS), and local control (LC) were tested with Cox regression analysis.
  
  
  RESULTS
  The median age at diagnosis was 35 years (range, 8-63 years). Twenty patients (39%) had surgery alone, 30 (59%) had surgery plus radiotherapy (RT), and 1 (2%) had RT only. At a median follow-up of 11 years (range, 0.2-37 years), 10-year OS, PFS, and LC for the entire group were 93%, 63%, and 67%, respectively. Nineteen patients (37%) had disease recurrence, and the recurrence was mostly local (79%). Twenty-eight of 50 patients who had surgery (56%) had gross total resection; 10-year LC was 56% after surgery vs 92% after surgery and RT (log-rank P = .14); the median time of LC was 10.5 years for patients receiving gross total resection plus RT, and 4.75 years for gross total resection only (P = .03). Among 16 patients with subtotal resection and follow-up data, 10-year LC was 0% after surgery vs 65% for surgery plus RT (log-rank P = .008). On multivariate analyses adjusting for resection type, age older that 35 years at diagnosis and receipt of adjuvant radiation were associated with improved PFS (hazard ratio [HR]: 0.14, P = .003 and HR: 0.45, P = .009) and LC (HR: 0.22, P = .02 and HR: 0.45, P = .009).
  
  
  CONCLUSIONS
  Postoperative radiotherapy after resection of MPE was associated with improved PFS and LC.
authors.affiliation: Departments of ‡Radiation Oncology and ¶Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas; §Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey; ‖School of Nursing, The University of Texas Health Science Center at Houston, Houston, Texas; #Department of Radiation Oncology, University of Southern California, Los Angeles, California.
authors.forename: Chiaojung Jillian
authors.initials: CJ
authors.lastname: Tsai
authors.forename: Yucai
authors.initials: Y
authors.lastname: Wang
authors.forename: Pamela K
authors.initials: PK
authors.lastname: Allen
authors.forename: Anita
authors.initials: A
authors.lastname: Mahajan
authors.forename: Ian E
authors.initials: IE
authors.lastname: McCutcheon
authors.forename: Ganesh
authors.initials: G
authors.lastname: Rao
authors.forename: Laurence D
authors.initials: LD
authors.lastname: Rhines
authors.forename: Claudio E
authors.initials: CE
authors.lastname: Tatsui
authors.forename: Terri S
authors.initials: TS
authors.lastname: Armstrong
authors.forename: Moshe H
authors.initials: MH
authors.lastname: Maor
authors.forename: Eric L
authors.initials: EL
authors.lastname: Chang
authors.forename: Paul D
authors.initials: PD
authors.lastname: Brown
authors.forename: Jing
authors.initials: J
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004806:Ependymoma / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D055815:Young Adult