Hwa Kyung Byun1, Seong Yi2, Hong In Yoon1, Se Hoon Kim3, Jaeho Cho1, Chang-Ok Suh4. 1. Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea. 2. Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Republic of Korea. 3. Department of Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea. 4. Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea. cosuh317@yuhs.ac.
Abstract
PURPOSE: This study evaluated the outcomes of radiotherapy (RT) for spinal ependymoma with adverse features, such as incomplete resection or disseminated disease. METHODS: Twenty-five patients underwent RT for spinal cord ependymoma during 1991-2016. Twenty-four patients had gross disease on the pre-RT spinal magnetic resonance images. Six patients (24%) had disseminated disease. The World Health Organization grades were I (12 patients), II (12 patients), and III (1 patient). The RT fields were the tumor bed plus margin in 19 patients (76%), the entire craniospinal axis in 5 patients (20%), and the entire spinal canal with posterior cranial fossa in 1 patient (4%). The median RT dose was 50.4 Gy (range 44.0-59.4 Gy). RESULTS: The median follow-up was 49 months (range 9-321 months), with 5-year overall and progression-free survival rates of 83.7% and 70.8%, respectively. Relative to patients with grade II/III ependymoma, patients with grade I ependymoma had higher 5-year rates of overall survival (100% vs. 69.4%, P = .088) and progression-free survival (100% vs. 42.3%, P = .02). Disease progression was observed in 4 patients who had grade II ependymoma, including 2 of 6 patients with disseminated disease and 2 of 19 patients with localized disease. Twelve patients (48%) exhibited improved neurological function. One patient who underwent craniospinal irradiation developed late hypopituitarism. No other RT-related late toxicities were observed. CONCLUSIONS: Favorable survival outcomes were achieved using RT for spinal ependymoma with adverse prognostic features. Thus, RT may be an effective treatment option when complete tumor removal cannot be achieved.
PURPOSE: This study evaluated the outcomes of radiotherapy (RT) for spinal ependymoma with adverse features, such as incomplete resection or disseminated disease. METHODS: Twenty-five patients underwent RT for spinal cord ependymoma during 1991-2016. Twenty-four patients had gross disease on the pre-RT spinal magnetic resonance images. Six patients (24%) had disseminated disease. The World Health Organization grades were I (12 patients), II (12 patients), and III (1 patient). The RT fields were the tumor bed plus margin in 19 patients (76%), the entire craniospinal axis in 5 patients (20%), and the entire spinal canal with posterior cranial fossa in 1 patient (4%). The median RT dose was 50.4 Gy (range 44.0-59.4 Gy). RESULTS: The median follow-up was 49 months (range 9-321 months), with 5-year overall and progression-free survival rates of 83.7% and 70.8%, respectively. Relative to patients with grade II/III ependymoma, patients with grade I ependymoma had higher 5-year rates of overall survival (100% vs. 69.4%, P = .088) and progression-free survival (100% vs. 42.3%, P = .02). Disease progression was observed in 4 patients who had grade II ependymoma, including 2 of 6 patients with disseminated disease and 2 of 19 patients with localized disease. Twelve patients (48%) exhibited improved neurological function. One patient who underwent craniospinal irradiation developed late hypopituitarism. No other RT-related late toxicities were observed. CONCLUSIONS: Favorable survival outcomes were achieved using RT for spinal ependymoma with adverse prognostic features. Thus, RT may be an effective treatment option when complete tumor removal cannot be achieved.
Authors: Daniel R Gomez; Brian T Missett; William M Wara; Kathleen R Lamborn; Michael D Prados; Susan Chang; Mitchel S Berger; Daphne A Haas-Kogan Journal: Neuro Oncol Date: 2005-07 Impact factor: 12.300
Authors: Jenna Kahn; Jay Steven Loeffler; Andrzej Niemierko; E Antonio Chiocca; Tracy Batchelor; Arnab Chakravarti Journal: Int J Radiat Oncol Biol Phys Date: 2010-10-13 Impact factor: 7.038
Authors: Chiaojung Jillian Tsai; Yucai Wang; Pamela K Allen; Anita Mahajan; Ian E McCutcheon; Ganesh Rao; Laurence D Rhines; Claudio E Tatsui; Terri S Armstrong; Moshe H Maor; Eric L Chang; Paul D Brown; Jing Li Journal: Neurosurgery Date: 2014-09 Impact factor: 4.654
Authors: Yimo Lin; Zachary A Smith; Albert P Wong; Stephanie Melkonian; Dominic A Harris; Sandi Lam Journal: Neurol Res Date: 2015-04-28 Impact factor: 2.448
Authors: Alessia Pica; Robert Miller; Salvador Villà; Sidney P Kadish; Yavuz Anacak; Huda Abusaris; Gokhan Ozyigit; Brigitta G Baumert; Renata Zaucha; Guy Haller; Damien C Weber Journal: Int J Radiat Oncol Biol Phys Date: 2009-02-26 Impact factor: 7.038
Authors: Oscar Persson; Alexander Fletcher-Sandersjöö; Gustav Burström; Erik Edström; Adrian Elmi-Terander Journal: Front Neurol Date: 2019-07-26 Impact factor: 4.003