Population based analysis ependymoma patients in Alberta from 1975 to 2007.
BACKGROUND
Ependymomas are rare tumors of the central nervous system whose management is controversial. This population-based study of adults and children with ependymoma aims to (1) identify clinical and treatment-related factors that impact survival and (2) determine if postoperative radiotherapy (RT) can improve survival of patients with subtotal resection (STR) to levels similar to patients who had gross total resection (GTR).


METHODS
This retrospective population-based study evaluated 158 patients with ependymoma diagnosed between 1975-2007 in Alberta, Canada.


RESULTS
Younger patients (<7 years of age) were more likely to be diagnosed with grade III tumors compared with adults in whom grade I tumors were more common (p=0.003). Adults were more likely to have spinally located tumors compared to young children whose tumors were typically found in the brain. Overall, young children with ependymoma were more likely to die than older children or adults (p=0.001). An equivalent number of patients underwent GTR as compared with STR (48% vs 45%, respectively). Overall, older age, spinal tumor location, lower grade, and GTR were associated with improved progression free survival but only GTR was associated with significant improvement in overall survival. Median survival after STR and RT was 82 months compared with 122 months in patients who had GTR (p=0.0022).


CONCLUSIONS
This is the first Canadian population-based analysis of patients with ependymoma including adults and children. Extent of resection appears to be the most important factor determining overall survival. Importantly, the addition of RT to patients initially treated with STR does not improve survival to levels similar to patients receiving GTR.
1Department of Medicine,University of Calgary,Alberta,Canada.
Gloria B
GB
Roldán Urgoiti
2Department of Medical Oncology,University of Calgary,Alberta,Canada.
Amitabh D
AD
Singh
2Department of Medical Oncology,University of Calgary,Alberta,Canada.
Roger Y
RY
Tsang
3Department of Radiation Oncology,Tom Baker Cancer Centre,University of Calgary,Alberta,Canada.
Robert A
RA
Nordal
3Department of Radiation Oncology,Tom Baker Cancer Centre,University of Calgary,Alberta,Canada.
Gerald
G
Lim
4Departments of Pathology and Laboratory Medicine,Clinical Neurosciences,and Oncology,University of Calgary,Alberta,Canada.
Jennifer A
JA
Chan
5Division of Neurosurgery,University of Calgary,Alberta,Canada.
Yves P
YP
Starreveld
6Division of Neurology,Department of Clinical Neurosciences,University of Calgary,Alberta,Canada.
Paula A
PA
de Robles
2Department of Medical Oncology,University of Calgary,Alberta,Canada.
Bradly J
BJ
Biagioni
5Division of Neurosurgery,University of Calgary,Alberta,Canada.
Mark G
MG
Hamilton
2Department of Medical Oncology,University of Calgary,Alberta,Canada.
Jacob C
JC
Easaw
D000293:Adolescent; D000328:Adult; D000416:Alberta / Q000453:epidemiology; D001932:Brain Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D004806:Ependymoma / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D012189:Retrospective Studies; D013120:Spinal Cord Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D015996:Survival Rate / Q000639:trends; D055815:Young Adult