title: Treatment of pediatric Grade II spinal ependymomas: a population-based study.
abstract: OBJECTIVE
  Grade II spinal cord ependymomas occurring in pediatric patients are exceptionally rare neoplasms. In this paper the authors use a national cancer database to determine patient demographics, treatment patterns, and associated outcomes of this cohort.
  
  
  METHODS
  The Surveillance Epidemiology and End Results (SEER) database was used to analyze subjects younger than 18 years with histologically confirmed diagnoses of Grade II spinal cord ependymoma from the years 1973 to 2008. Descriptive data on the demographic characteristics of this cohort and the associated treatment patterns are shown. The Kaplan-Meier method was used to estimate overall survival at 1, 2, 5, and 10 years.
  
  
  RESULTS
  This cohort comprised 64 pediatric subjects with Grade II spinal ependymoma. The median age was 13 years, nearly half of the patients were male, and most were white (84%). The median follow-up was 9.2 years. Overall survival at 5 and 10 years was 86% and 83%, respectively. Gross-total resection was achieved in 57% of subjects, and radiation therapy was administered to 36%. Radiation therapy was administered to 78% of subjects after subtotal resection but only to 19% of patients after gross-total resection; this difference was significant (p < 0.001). In a multivariate regression model analyzing sex, age at diagnosis, year of diagnosis, radiotherapy, and extent of resection, female sex was found to be an independent predictor of decreased mortality (HR 0.15 [95% CI 0.02-0.94], p = 0.04).
  
  
  CONCLUSIONS
  These data show long-term outcomes for pediatric patients with Grade II spinal ependymoma. Radiotherapy was more likely to be administered in cases of subtotal resection than in cases of gross-total resection. Female sex is associated with decreased mortality, while other demographic or treatment modalities are not.
authors.affiliation: Division of Pediatric Neurosurgery, Texas Children's Hospital, and Department of Neurosurgery, Baylor College of Medicine; and.
authors.forename: Yimo
authors.initials: Y
authors.lastname: Lin
authors.forename: Andrew
authors.initials: A
authors.lastname: Jea
authors.forename: Stephanie C
authors.initials: SC
authors.lastname: Melkonian
authors.forename: Sandi
authors.initials: S
authors.lastname: Lam
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D004806:Ependymoma / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D060787:Neoplasm Grading; D019635:Neurosurgical Procedures / Q000379:methods*; D018714:Radiotherapy, Adjuvant; D018426:SEER Program; D012737:Sex Factors; D013120:Spinal Cord Neoplasms / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: GTR = gross-total resection; ICD-O-3 = The International Classification of Diseases for Oncology, Third Edition; NOS = not otherwise specified; OS = overall survival; PFS = progression-free survival; SEER; SEER = Surveillance Epidemiology and End Results; STR = subtotal resection; children; ependymoma; oncology; pediatric; spinal cord ependymoma; spinal cord tumor; spine