Debra Nana Yeboa1, Kia-Ping Liao2, Beverly Ashleigh Guadagnolo3, Ganesh Rao4, Andrew Bishop5, Caroline Chung5, Jing Li5, Claudio Esteves Tatsui4, Laurence D Rhines4, Sherise Ferguson4, Arnold de la Cruz Paulino5, Amol Jitendra Ghia5. 1. Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA; Department of Health Services Research, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA. Electronic address: dnyeboa@mdanderson.org. 2. Department of Health Services Research, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA. 3. Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA; Department of Health Services Research, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA. 4. Department of Neurosurgery, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA. 5. Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA.
Abstract
BACKGROUND: Spinal ependymomas are rare, with an incidence of 1 per 100,000. Given the paucity of data for higher grade II and III disease, the management and patterns of care require further investigation. METHODS: Our study of 1345 patients with higher-grade spinal ependymoma used χ2 tests and simple and multivariable logistic regression models to assess demographic and clinical factors associated with therapy. Kaplan-Meier and log-rank tests were used to assess overall survival (OS). RESULTS: Most grade II patients received surgery alone (81.1%) compared with 36.8% of grade III. Approximately 60% of patients with grade III ependymomas received radiotherapy (RT) versus 15.3% of grade II (P < 0.001). Patients living ≤32 km (20 miles) from a facility were more likely to receive RT (P < 0.001) than were those living further away. On multivariable logistic regression, grade (grade III, odds ratio, 8.6; P < 0.001) and facility distance were significantly associated with receipt of RT (P < 0.0001). The 5-year and 10-year OS was 94.7%/85.1% for patients with grade II disease and 58.2%/46.4% for grade III disease (P < 0.0001). OS was highest at facilities treating an average of 15 patients over 10 years, corresponding to the top 81st percentile in volume. The 10-year OS was 92.6% at facilities treating at least 15 patients and 88.0% at facilities treating 6-14 patients. CONCLUSIONS: Approximately 40% of patients with grade III ependymomas do not receive immediate adjuvant therapy, which may be related to distance from a facility. Patients with this rare tumor may benefit from multidisciplinary care at facilities with a larger volume.
BACKGROUND:Spinal ependymomas are rare, with an incidence of 1 per 100,000. Given the paucity of data for higher grade II and III disease, the management and patterns of care require further investigation. METHODS: Our study of 1345 patients with higher-grade spinal ependymoma used χ2 tests and simple and multivariable logistic regression models to assess demographic and clinical factors associated with therapy. Kaplan-Meier and log-rank tests were used to assess overall survival (OS). RESULTS: Most grade II patients received surgery alone (81.1%) compared with 36.8% of grade III. Approximately 60% of patients with grade III ependymomas received radiotherapy (RT) versus 15.3% of grade II (P < 0.001). Patients living ≤32 km (20 miles) from a facility were more likely to receive RT (P < 0.001) than were those living further away. On multivariable logistic regression, grade (grade III, odds ratio, 8.6; P < 0.001) and facility distance were significantly associated with receipt of RT (P < 0.0001). The 5-year and 10-year OS was 94.7%/85.1% for patients with grade II disease and 58.2%/46.4% for grade III disease (P < 0.0001). OS was highest at facilities treating an average of 15 patients over 10 years, corresponding to the top 81st percentile in volume. The 10-year OS was 92.6% at facilities treating at least 15 patients and 88.0% at facilities treating 6-14 patients. CONCLUSIONS: Approximately 40% of patients with grade III ependymomas do not receive immediate adjuvant therapy, which may be related to distance from a facility. Patients with this rare tumor may benefit from multidisciplinary care at facilities with a larger volume.
Authors: David R Ghasemi; Martin Sill; Konstantin Okonechnikov; Andrey Korshunov; Stephen Yip; Peter W Schutz; David Scheie; Anders Kruse; Patrick N Harter; Marina Kastelan; Marlies Wagner; Christian Hartmann; Julia Benzel; Kendra K Maass; Mustafa Khasraw; Ronald Sträter; Christian Thomas; Werner Paulus; Christian P Kratz; Hendrik Witt; Daisuke Kawauchi; Christel Herold-Mende; Felix Sahm; Sebastian Brandner; Marcel Kool; David T W Jones; Andreas von Deimling; Stefan M Pfister; David E Reuss; Kristian W Pajtler Journal: Acta Neuropathol Date: 2019-08-14 Impact factor: 17.088