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

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.     

Multivariate Analysis of Clinical Prognostic Factors in Children with Intracranial Ependymomas

The optimal postoperative management of pediatric intracranial ependymomas is controversial. We analyzed clinical prognostic factors for their influence on outcome in such children. Our retrospective series included 15 with supratentorial and 28 with infratentorial tumors. Twenty ependymomas were grade II, and 23 were anaplastic. Complete resection was performed in 18 patients, incomplete resection in 19, and stereotactic biopsy in 6. Radiotherapy was done in 31 patients and chemotherapy in 13. The surviving patients have been followed 8-232 months (median: 69 months). The median survival time was 30 months, and 5-year overall survival and progression-free survival rates were 53.9% and 45.9%, respectively. By tumor site: supratentorial, 56.6% and 50.9%; infratentorial, 52.3% and 42.5%. Multivariate analysis identified complete resection (5-year progression-free survival, 71.8%) and age <3 years old as significant favorable and adverse prognostic features (relative risk, 2.59; 95% CI, 1.05-6.38), respectively. Twenty-six children relapsed 1-107 months after diagnosis (median: 12 months). Relapses were local in 22 cases, and combined local and distant in three cases. Only one of 15 patients with supratentorial tumors developed isolated spinal metastasis. Failure at the primary site is the major obstacle to improve cure rates. The extent of surgical resection and age were the only statistically significant prognostic factors.     

Outcomes in treatment for intradural spinal cord ependymomas

PURPOSE: Spinal cord ependymomas are rare tumors, accounting for <2% of all primary central nervous system tumors. This study assessed the treatment outcomes for patients diagnosed with spinal cord ependymomas within the Southern California Kaiser Permanente system. METHODS AND MATERIALS: We studied 23 patients treated with surgery with or without external beam radiotherapy (EBRT). The local and distant control rates and overall survival rates were determined. RESULTS: The overall local control, overall recurrence, and 9-year overall survival rate was 96%, 17.4%, and 63.9%, respectively. CONCLUSIONS: The results of our study indicate that en bloc gross total resection should be the initial treatment, with radiotherapy reserved primarily for postoperative cases with unfavorable characteristics such as residual tumor, anaplastic histologic features, or piecemeal resection. Excellent local control and overall survival rates can be achieved using modern microsurgical techniques, with or without local radiotherapy.     

Adjuvant radiotherapy delays recurrence following subtotal resection of spinal cord ependymomas

Background

Ependymoma is the most common glial tumor of the adult spinal cord. Current consensus recommends surgical resection with gross total resection (GTR) whenever possible. We performed a comprehensive review of the literature to evaluate whether adjuvant radiotherapy after subtotal resection (STR) has any benefit.

Methods

A PubMed search was performed to identify adult patients with spinal cord ependymoma who underwent surgical resection. Only patients who had clearly defined extent of resection with or without adjuvant radiotherapy were included for analysis. Kaplan-Meier and multivariate Cox regression survival analyses were performed to determine the effects of adjuvant radiotherapy on progression-free survival (PFS) and overall survival (OS).

Results

A total of 348 patients underwent surgical resection of spinal cord ependymomas, where GTR was obtained in 77.0% (268/348) of patients. Among those who received STR, 58.8% (47/80) received adjuvant radiotherapy. PFS was significantly prolonged among those who received adjuvant radiotherapy after STR (log rank; P < .001). This prolonged PFS with adjuvant radiotherapy remained significant in multivariate Cox regression analysis (STR versus STR + RT group; hazard ratio (HR) = 2.26, P = .047). By contrast, improved OS was only associated with GTR (GTR versus STR + RT group; HR = 0.07, P = .001) and benign ependymomas (HR = 0.16, P = .001).

Conclusions

Surgery remains the mainstay treatment for spinal cord ependymomas, where GTR provides optimal outcomes with longest PFS and OS. Adjuvant radiotherapy prolongs PFS after STR significantly, and OS is improved by GTR and benign tumor grade only.     

Late Dissemination of Fourth Ventricle Ependymoma: A Case Report

Dissemination of benign ependymoma is relatively rare, especially when a local tumor is under control. The majority of the failures take place within a few years after surgery. However, we experienced a case in which multiple spinal cord dissemination was found 13 years after resection of the fourth ventricle ependymoma without a local failure. A 38-year-old man had undergone a subtotal resection of the fourth ventricle ependymoma and radiation therapy to the posterior fossa when he was 25 years old. Follow-up MR imaging repeated once every one or two years detected no recurrence until he began to complain of lumbago and numbness of the right foot 13 years after the surgery. MR imaging revealed multiple nodules along the whole spinal cord. Examination of the cerebrospinal fluid detected tumor cells with ependymal cell features. He underwent radiation therapy to the whole spine, and remained stable at 18 months after the therapy. This case alerts us to the necessity for long-term radiological follow-up including the spinal cord even in benign ependymomas, although it is still not certain for how long and how often we should do it.     

The results of radiotherapy for ependymomas: the mayo clinic experience

Purpose: This analysis was performed to examine the outcome of patients with histologically confirmed ependymomas of the brain or spinal cord who received postoperative radiotherapy.

Methods and Materials: Eighty patients with histologically confirmed ependymomas were evaluated retrospectively. All were treated with various combinations of surgery, radiotherapy (RT), and chemotherapy. Follow-up ranged from 5 to 30 years (median 10.4 years).

Results: The 5- and 10-year survival rates for the entire study group were 79% and 73%, respectively. Patients with low-grade (1 and 2 of 4) tumors had a 5-year survival rate of 87% as compared to 27% for those with high-grade (3 and 4 of 4) tumors (p < 0.0001). Patients with tumors of the spine had a 5-year survival rate of 97% as compared to 68% for those with infratentorial tumors, and 62% for those with supratentorial tumors (p = 0.03). Patients with myxopapillary ependymomas of the spine had a 5-year survival rate of 100% as compared with 76% for patients with other histological subtypes of ependymoma (p = 0.02). Multivariate analysis revealed that the survival rate was independently associated with tumor grade (p = 0.0007) and histological subtype (p = 0.02). Twenty-eight patients (35%) experienced local failure and 10 patients (13%) developed leptomeningeal seeding. The 5-year leptomeningeal failure rate was 10% in patients with low-grade tumors as compared to 41% for patients with high grade tumors (p = 0.01).

Conclusion: Patients with low-grade tumors, especially those with myxopapillary subtypes, have high 5-year survival rates when treated with post-operative radiotherapy. High grade ependymomas are associated with a much poorer outcome. New forms of therapy are required to improve the outcome of patients with high-grade ependymomas.     

Surgical Outcome and Prognostic Factors of Spinal Intramedullary Ependymomas in Adults

The goal of treatment for spinal ependymoma is complete removal with minimal postoperative neurological deficit. The authors correlated the results of surgical management for spinal cord ependymoma with the rate of postoperative disease progression and the prognostic factors. Thirty-one cases of spinal ependymomas, surgically treated between 1979 and 1998, were retrospectively analyzed. The authors reviewed clinical features, radiological characteristics and operative findings for the surgical outcome analysis. Thirty-five percent of patients with preoperative Nuricks grade better than grade 4 showed improvement in functional status, whereas no improvement was observed in patients with preoperatively poorer functional status (P=0.05). The proportion of complete surgical removals was influenced by tumor location (40% in cases around the conus versus 97% in other regions, P=0.003) and histology (42% in the myxopapillary subtype versus 97% in the non-myxopapillary subtype, P=0.001). Disease progression was observed in six cases, the mean progression free interval after surgical removal was 83 months and the 5-year progression free rate was 70%. Disease progression was found in two out of 23 cases from the complete removal group and in four out of eight cases from the incomplete removal group (P=0.008). In the aspect of disease progression, the only statistically significant factor by multivariate analysis was the surgical extent of removal (P=0.010). Of those patients where there was incomplete removal, radiation therapy lead to improved clinical results, which were not statistically significant (P=0.27). In the surgical treatment of spinal cord ependymoma, preoperative functional status and the extent of removal were the significant prognostic factors influencing postoperative outcome. Early diagnosis is vital and complete removal of the tumor should be attempted in all surgical treatment of spinal ependymoma.     

Postoperative radiotherapy of primary spinal cord tumors

During the 30 year period from 1957 to 1986, 42 patients with primary tumors arising from the spinal cord or cauda equina received postoperative irradiation at the University of California, San Francisco. Twenty-one patients had ependymomas: 18 were localized to one site, and 3 diffusely involved the cord. There were 12 patients with low grade astrocytomas and 3 with highly anaplastic astrocytoma or glioblastoma multiforme. All astrocytomas were localized at presentation. In 6 cases tissue was insufficient to permit a histologic diagnosis. Thirty-nine patients (93%) received total radiation doses ranging between 45.0-54.7 Gy using standard fractionation. The 10-year actuarial disease-specific survival rate for patients with localized ependymoma was 93%; 33% of these tumors recurred locally. The corresponding rate for diffuse ependymomas was 50%; the spinal disease was controlled in all 3 patients, but one developed a cerebral metastasis despite prophylactic cranial irradiation. Low-grade astrocytoma patients had a 10-year actuarial disease-specific survival rate of 91%, with 33% of these tumors recurring locally. No patient with highly anaplastic astrocytoma or glioblastoma multiforme survived longer than 8 months; all of these tumors recurred locally, and two of the three also developed diffuse craniospinal axis metastases. Local recurrence for ependymoma was delayed as long as 12 years following treatment, while all but one astrocytoma failure occurred within 3 years of treatment. No significant dose-response relationship with respect to local control was noted for either localized ependymomas or low grade astrocytomas. One patient developed radiation myelitis after receiving 50.4 Gy with standard fractionation. These results indicate that patients who undergo postoperative irradiation for low grade spinal astrocytomas and localized spinal ependymomas achieve excellent survival. However, despite treatment with total radiation doses taken to the practical limit of spinal cord tolerance, local failure remains common.     

Intracranial ependymoma long term outcome,patterns of failure

We analyzed 31 patients with intracranial ependymoma, all verified by secondary neuropathology review. There were 12 patients with ependymomas and 19 patients with anaplastic ependymoma by the WHO classification. Eight patients received craniospinal irradiation, 22 patients received cranial irradiation alone, and one patient was treated with chemotherapy alone. The median follow-up time was 11 years. The 5- and 10-year progression-free survivals (PFS) were 60% and 48%. Those with anaplastic tumors had a decreased 10 year PFS over those with low grade lesions: 26% vs. 55% (p=0.02). Delivering spinal irradiation in addition to cranial irradiation did not improve outcome. There were relapses in 16 patients. All patients relapsed at the primary intracranial sites with no spinal failures. Patients treated with whole brain irradiation had decreased 10 year PFS over those treated with local fields: 19% vs. 64% (p=0.006). Those patients treated to 50 Gy had an improved long-term PFS (p=0.04). Multivariate analysis was undertaken with the following variables: extent of cranial irradiation, pathology, anatomic site of ependymoma, cranial irradiation dose, extent of surgery, and whether spinal irradiation was given. With PFS as the endpoint, only extent of cranial irradiation (favoring local fields) and pathology (favoring low grade ependymoma) were significant prognosticators. We conclude that carefully outlined local field irradiation is the therapy of choice, and elective spinal irradiation is of questionable benefit.     

Ependymoma: Results,Prognostic Factors and Treatment Recommendations

Purpose: To review the University of Florida experience in treating ependymomas, analyze prognostic factors, and provide treatment recommendations.Methods and Materials: Forty-one patients with ependymoma and no metastases outside the central nervous system received postoperative radiotherapy with curative intent between 1966 and 1989. Ten patients had supratentorial lesions, 22 had infratentorial lesions, and 9 had spinal cord lesions. All patients had surgery (stereotactic biopsy, subtotal resection, or gross total resection). Most patients with high-grade lesions received radiotherapy to the craniospinal axis. Low-grade intracranial lesions received more limited treatment. Spinal cord lesions were treated using either partial spine or whole spine fields.Results: Of 32 intracranial tumors, 21 recurred, all at the primary site; no spinal cord tumors recurred. Overall 10-year survival rates were 51% (absolute) and 46% (relapse-free); by tumor site: spinal cord, 100%; infratentorial, 45%; supratentorial, 20% (p = 0.002). On multivariate analysis, tumor site was the only factor that influenced absolute survival (p = 0.0004); other factors evaluated included grade, gender, age, duration of symptoms, resection extent, primary tumor dose, treatment field extent, surgery-to–radiotherapy interval, and days under radiotherapy treatment.Conclusions: Patients with supratentorial or infratentorial tumors receive irradiation, regardless of grade. Craniospinal-axis fields are used when spinal seeding is radiographically or pathologically evident. Spinal cord tumors are treated using localized fields to the primary site if not completely resected. Failure to control disease at the primary site remains the main impediment to cure.     

Intracranial ependymomas treated with radiotherapy: long-term results from a single institution

The purpose of the study is to report long-term outcomes following surgery and radiotherapy for intracranial ependymoma. We retrospectively reviewed the medical records of patients treated with radiotherapy for localized intracranial ependymomas from 1964 to 2006. Patients with subependymomas and ependymoblastomas, and those undergoing re-irradiation, were excluded. Our study population is 44 patients: 37 infratentorial lesions, 7 supratentorial. All patients had postoperative radiotherapy; most received sub-total resection and one-third received gross total resection. Most patients received local radiotherapy alone (median tumor dose 55 Gy); one-quarter received craniospinal irradiation (median dose 35 Gy). The 5- and 10-year local-control rates for all patients were 60 and 46%, respectively; 23% of local recurrences occurred after 5 years. Ninety-five percent of the patients recurred at the primary site; 5% had spinal seeding with no evidence of disease at the primary site. No patient who received craniospinal irradiation recurred in the spine. The 5- and 10-year disease-free survival and overall-survival rates for all patients were 60 and 42% and 57 and 43%, respectively. On multivariate analysis, age ≥18 years, gross total resection and infratentorial site were associated with improved local control. No patient with continuous local control had grade 4 or 5 toxicities; 27% of patients had grade 2 or 3 toxicities. One patient developed a radiation-induced meningioma >20 years after radiotherapy. Maximal safe resection followed by adjuvant radiotherapy provided local control in one-half of patients at 10 years. Age, extent of surgery, and location were identified as major independent prognostic factors in patients with intracranial ependymomas.     

Improved localization of infratentorial ependymoma by magnetic resonance imaging: Implications for radiation treatment planning

Ependymomas of the posterior fossa extend into the upper cervical spinal cord in approximately one-third of cases. Unfortunately, the posterior fossa and upper cervical cord region is often poorly seen on computed tomography (CT), making radiotherapy planning difficult. We report five cases of posterior fossa ependymoma with extension into the cervical cord where magnetic resonance imaging (MRI) demonstrated the caudal extent of tumor more clearly than CT. The extent of tumor depicted by MRI in each case correlated well with the operative findings. Higher doses of radiotherapy to the entire tumor volume are associated with improved survival in infratentorial ependymoma; however, the radiation tolerance of the cervical spinal cord is close to the dose necessary to control posterior fossa ependymoma, making limitation of radiation field volumes important. MRI may provide a method of precisely defining caudal tumor extent of posterior fossa ependymomas so that limited volume, high dose radiotherapy can be more safely administered to these patients.     

Combined postoperative irradiation and chemotherapy for anaplastic ependymomas in childhood: results of the German prospective trials HIT 88/89 and HIT 91

PURPOSE: To evaluate the outcome in children with anaplastic ependymomas after surgery, irradiation, and chemotherapy; and to identify prognostic factors for survival. METHODS AND MATERIALS: Fifty-five children (n = 27 girls, 28 boys; median age at diagnosis, 6.2 years) with newly diagnosed anaplastic ependymomas were treated in the multicenter, prospective trials HIT 88/89 and HIT 91. Macroscopic complete resection was achieved in 28 patients; 27 patients underwent incomplete resection. All patients received chemotherapy before (n = 40) or after irradiation (n = 15). The irradiation volume encompassed either the neuraxis followed by a boost to the primary tumor site (n = 40) or the tumor region only (n = 13). No radiotherapy was administered in two patients. RESULTS: Median follow-up was 38 months. The overall survival rate at 3 years after surgery was 75.6%. Disease progression occurred in 25 children with local progression occurring in 20. The median time to disease progression was 45 months. The only significant prognostic factor was the extent of resection (estimated progression-free survival [EPFS] after 3 years was 83.3% after complete resection and 38.5% after incomplete resection) and the presence of metastases at the time of diagnosis (0% vs. 65.8% 3-year EPFS in localized tumors). Age, sex, tumor site, mode of chemotherapy, and irradiation volume did not influence survival. CONCLUSIONS: Treatment centers should be meticulous about surgery and diagnostic workup. Because the primary tumor region is the predominant site of failure it is important to intensify local treatment. Dose escalation by hyperfractionation or stereotactic radiotherapy might be a promising approach in macroscopically residual disease. The role of adjuvant chemotherapy requires further study.     

儿童脊髓室管膜瘤术后放射治疗的疗效和预后分析

  目的  研究儿童脊髓室管膜瘤的临床特点、治疗转归和预后。  方法  回顾性分析2011年1月至2018年12月首都医科大学附属北京世纪坛医院收治的经病理证实的11例儿童脊髓室管膜瘤放射治疗患者的临床资料,观察疗效并结合文献进行分析。  结果  中位随访59个月,7例发生术后复发、播散,1例患儿死于疾病进展。放疗剂量为36.0~55.8 Gy,5次/周,1.7~1.8 Gy/次,平均剂量45.0 Gy。所有患儿放疗过程中未发生严重不良反应。3、5、8年无进展生存率（progression free survival,PFS）分别为42.4%、28.3%、28.3%。3、5、8年总生存率（overall survival,OS）分别为100%、87.5%、87.5%。  结论  手术切除程度是影响儿童脊髓室管膜瘤预后最重要的因素,对于肿瘤残存或间变性室管瘤患儿,术后放射治疗能有效提高局部控制率。      

Extraneural metastases in ependymoma

Summary Ependymomas, glial neoplasms usually arising in the posterior fossa or spinal cord, rarely metastasize outside the central nervous system. We have reviewed all 81 ependymomas evaluated at MSKCC between 1956–1989. Five (6.2%) had extraneural metastases (ENM). The primary tumor was in spinal cord in 3 patients and the cerebral hemisphere in 2. Two tumors were histologically anaplastic; 3 were histologically benign. The 5 patients were 3, 3, 3.5, 16 and 37 years old. Time from initial diagnosis to development of ENM was 0, 15, 35, 40, and 288 months. At the time of ENM the primary tumor was progressing in 4/5 patients. Prior therapy had included resection plus radiation therapy (RT) (1), RT plus chemotherapy (1), resection plus RT plus chemotherapy (2). One patient had not received prior therapy because ENM were present at diagnosis. The sites of ENM included lung and thoracic lymph nodes (2), pleura and peritoneum (2), and liver (1). Both patients with peritoneal ENM had had ventriculoperitoneal shunts. ENM did not correlate with histologic grade, age, or degree of surgical resection. When patients with ependymoma develop signs or symptoms of systemic disease such as abdominal pain, cough, or adenopathy, ENM should be considered.     

Spinal cord ependymomas in adults: analysis of 15 cases

This retrospective analysis was performed to examine the outcome of patients with spinal cord ependymomas treated with surgery and postoperative radiation therapy between 1982 and 1998. There were 10 male and 5 female patients, ranging from 16 to 74 years of age with a median age of 38 years. Surgery was gross total resection in 2 patients, subtotal resection in 10, biopsy in 3. All patients received radiation therapy with a total dose of 40-56 Gy. The 5 and 10 year overall survival rates were 83.3 and 83.3%, respectively. Twelve patients are still alive at a median follow-up period of 70 months. Of the 15 patients, 6 developed recurrent disease on follow-up. The median time to recurrence was 45 months (range: 24-80 months). Local failure within the initial irradiated volume occurred in 3 out of 6 patients who received less than 45 Gy and 2 out of 8 patients treated with more than 45 Gy. Four out of the six failures were salvaged with additional treatment. Re-irradiation was used as a part of salvage or sole treatment in 3 cases. The patient who was salvaged with radiation therapy only died of disease progression 41 months following recurrence and the other two who received a combination of surgery, radiotherapy or chemotherapy were still alive 57 and 30 months following relapse. The present study shows that surgery and post-operative radiation treatment for spinal ependymoma patients resulted in high survival rates. Patients with residual disease after surgery should be treated with radiation therapy with a dose of more than 45 Gy. Re-irradiation may be the treatment of choice for recurrent patients having less than complete resection or no surgery.     

Hypofractionated radiotherapy boost for dose escalation as a treatment option for high-grade spinal cord astrocytic tumor

Summary Purpose To retrospectively analyze the outcome of post-operative radiotherapy for spinal cord glioma with the emphasis on the hypofractionated radiotherapy boost for dose escalation as a treatment option for high-grade spinal cord astrocytic tumors. Materials and methods Forty-one patients with spinal cord glioma received post-operative radiotherapy between 1979 and 2003. The median age was 34 years (range, 10–66 years). Median follow-up was 49 months (range, 5–291 months). There were 12 low-grade astrocytic tumors, 11 high-grade astrocytic tumors, 16 low-grade ependymal tumors and 2 high-grade ependymal tumors. Among 11 patients with high-grade astrocytic tumors, 5 with anaplastic astrocytoma and 1 with glioblastoma received hypofractionated radiotherapy boost for dose escalation. The median total dose of the conventional radiotherapy was 45.5 Gy in 19 fractions (range, 30.0–60.0 Gy). The median normalized total dose (using daily dose of 2.0 Gy and an α/‰β ratio of 2.0) of the hypofractionated radiotherapy boost was 131 Gy₂ (range, 85–249). Results The Kaplan–Meier survival rates at 10 years from the date of the first surgery were 64% for the entire group, 47% for the astrocytic tumors and 84% for the ependymal tumors, respectively (P=0.009). Among 11 patients with high-grade astrocytic tumors, the actuarial survival rate at 10 years was 35%. The actuarial survival rates at 10 years were 67% for those who received hypofractionated radiotherapy boost for dose escalation, and 20% for those who did not (P=0.47). Discussion The results for ependymal tumors and low-grade astrocytic tumors were comparable to those reported in the literature. Hypofractionated radiotherapy boost for dose escalation may help to prolong the survival of patients with high-grade astrocytic tumors.     

脊髓髓内室管膜瘤的显微外科治疗——附173例临床总结

背景与目的：随着神经影像技术，显微外科技术和术中监测手段的发展，大多数脊髓髓内肿瘤的早期诊断和治疗已成为现实。本研究旨在探讨显微外科手术治疗脊髓室管膜瘤的经验。方法：回顾性研究北京天坛医院神经外科脊柱脊髓组从2000年1月至2005年4月经显微外科手术治疗的髓内室管膜瘤173例，并分析其预后影响因素。结果：肿瘤全切除163例（94．2％），近全切除8例（4．6％），大部分切除2例（1．2％），出院3-6个月门诊随访好转142例（76．3％），余随访不全。结论：积极的显微外科治疗，争取全切是髓内室管膜瘤治疗的最佳选择，术前神经功能状况、肿瘤的性质与部位、手术技巧与切除程度等都是影响预后的重要因素。     

脊髓室管膜瘤术后放射治疗的疗效及预后影响因素分析

目的:探讨脊髓室管膜瘤术后放疗疗效及预后影响因素。方法:回顾性分析2009年1月至2018年12月首都医科大学附属北京世纪坛医院放疗科收治的经病理证实的32例脊髓室管膜瘤术后放射治疗患者的临床资料,观察疗效并进行预后影响因素分析。生存分析采用Kaplan-Meier法,单因素分析采用Log-Rank法,多因素分析采用Cox比例风险回归模型评估。结果:中位随访61.5月,11例发生术后复发,复发时间在1～80月,平均39.4月,9例为原位复发,2例发生全中枢播散。随访中,患者死亡3例,均为肿瘤相关死亡。3年、5年无进展生存(PFS)率分别为 68.8%(22/32)、65.6%(21/32),3年、5年总生存(OS)率分别为93.8%(30/32)、90.6%(29/32)。手术切除程度、病理级别、放疗对无进展生存率具有显著性影响（P=0.012、P=0.004、P=0.000）,全切除术组患者的总生存率明显优于次全切除术组,两组差异具有统计学意义(P=0.001)。性别、年龄、术后化疗既不影响无进展生存率,也不影响总生存率。Cox比例风险回归模型进行多因素预后分析,结果显示术后放疗影响脊髓室管膜瘤患者的无进展生存率,差异具有统计学意义(HR=0.061,95%CI:0.016~0.237,P=0.000)。结论:手术是室管膜瘤的首选治疗方法。部分切除和间变性室管膜瘤患者,术后放疗是重要的辅助治疗手段;手术切除程度、病理级别和放疗影响室管膜瘤患者预后。     

儿童颅内室管膜瘤术后放射治疗16例临床分析

目的　观察儿童颅内室管膜瘤术后放射治疗的疗效。方法　 1991年 1月～ 1998年 2月 ,16例儿童颅内室管膜瘤接受术后放疗。结果　本组总的 1、3、5年生存率分别为 10 0 .0 %、72 .9%、5 4 .7%。低分级室管膜瘤、肿瘤全部切除和照射剂量 >4 0Gy的 5年生存率分别为 6 2 .2 %、6 4 .3%、6 4 .3% ,分别高于高分级室管膜瘤、肿瘤部分切除和照射剂量 <4 0Gy的 4 7.6 %、4 4 .4 %、0。本组死亡 6例 ,其中 3例死于局部复发 ,占死亡患儿的 5 0 .0 % (3/ 6 ) ,2例死于局部残留病灶进展。结论　室管膜瘤的术后放疗可明显提高患儿的生存率。病理类型、手术切除范围和照射剂量是影响预后的重要因素。局部复发或局部残留病灶进展是治疗失败的主要原因。