Long-term outcomes of spinal ependymomas: an institutional experience of more than 60 cases

Rohan Savoor, Timothy L. Sita, Nader S. Dahdaleh, Irene Helenowski, John A. Kalapurakal, Maryanne H. Marymont, Rimas Lukas, Timothy J. Kruser, Zachary A. Smith, Tyler Koski, Aruna Ganju, Sean Sachdev*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Spinal ependymomas represent the most common primary intramedullary tumors for which optimal management remains undefined. When possible, gross total resection (GTR) is often the mainstay of treatment, with consideration of radiotherapy (RT) in cases of residual or recurrent tumor. The impact of extent of resection and radiotherapy remain understudied. Objective: Report on a large institutional cohort with lengthy follow-up to provide information on long-term outcomes and to contribute to limited data assessing the value of extent of resection and RT. Methods: Patients with pathologically proven primary spinal ependymoma between 1990 and 2018 were identified. Kaplan-Meier estimates were used to calculate progression-free survival (PFS); local-control (LC) and overall survival (OS). Logistic regression was used to analyze variables’ association with receipt of RT. Results: We identified 69 patients with ependymoma of which 4 had leptomeningeal dissemination at diagnosis and were excluded. Of the remaining cohort (n = 65), 42 patients (65%) had Grade II spinal ependymoma, 20 (31%) had Grade I myxopapillary ependymoma and 3 (5%) had Grade III anaplastic ependymoma; 54% underwent GTR and 39% underwent RT. With a median follow-up of 5.7 years, GTR was associated with improved PFS. For grade II lesions, STR+RT yielded better outcomes than STR alone (10y PFS 77.1% vs 68.2%, LC 85.7% vs 50%). Degree of resection was the only significant predictor of adjuvant radiotherapy (p< 0.0001). Conclusion: Our findings confirm the importance of GTR in spinal ependymomas. Adjuvant RT should be utilized in the setting of a subtotal resection with expectation of improved disease-related outcomes.

Original languageEnglish (US)
Pages (from-to)241-247
Number of pages7
JournalJournal of Neuro-Oncology
Volume151
Issue number2
DOIs
StatePublished - Jan 2021

Keywords

  • Ependymoma
  • Radiotherapy
  • Resection
  • Spine
  • Surgery

ASJC Scopus subject areas

  • Oncology
  • Neurology
  • Clinical Neurology
  • Cancer Research

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