Postoperative Radiotherapy for Patients with Intracranial Ependymoma: Patterns of Failure and Role of Craniospinal Radiotherapy

Article Outline

• Purpose/Objective(s)
• Materials/Methods
• Results
• Conclusions
• Copyright

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Purpose/Objective(s) 

To analyze the outcome of intracranial ependymoma patients treated with surgery and postoperative radiotherapy and to evaluate the role of craniospinal radiotherapy (CSRT).

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Materials/Methods 

From January 1979 through June 2006, 70 patients with intracranial ependymoma received radiotherapy with curative intent at our institution. World Health Organization (WHO) Grade I, II, and III ependymoma were found in 1, 56, and 13, respectively. The median patient age was 9.7 years (range, 1.3-62.7 years). The majority of patients were male (59%), and had infratentorial tumor (83%). Seven patients (10%) had M+ disease at initial diagnosis. Gross total resection was achieved in 21 patients (30%), near total resection in 14 (20%), subtotal resection in 29 (41%), partial resection in 4 (6%), and biopsy only in 2 (3%). All patients received postoperative radiotherapy to a median total dose of 54 Gy (range, 44.7-61.2 Gy). A CSRT was used in 40 patients (57%). Median radiotherapy treatment duration was 48 days (range, 37-104 days). Twelve patients (17%) received chemotherapy. The median follow-up duration was 52 months (range, 3 ∼228).

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Results 

The 5-year and 10-year overall survival (OS) rates for all patients were 86.2% and 62.9%, respectively. The 5-year and 10-year progression free survival (PFS) rates for all patients were 46.3% and 34.9%, respectively. The 5-year and 10-year OS rates for patients aged ≤4 years were 70.6% and 34.9%, compared with 91.8% and 75.8% for patients aged >4 years (p = 0.041). For 63 patients with M0 disease, there were no significant differences in OS, PFS, and leptomeningeal failure rates between the patients with CSRT and those without CSRT. Thirty-two (51%) patients with M0 disease had progressed disease as follows: local in 25 patients, leptomeninges in 2, and local plus leptomeninges in 5. In patients with M+ disease, 2 had progressed disease (leptomeninges). In patients with WHO Grade III ependymoma, there was no leptomeningeal failure. Twenty-eight patients with progressed disease had salvage treatment and 20 patients were successfully salvaged.

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Conclusions 

Our data suggested that CSRT has no role in M0 ependymoma because the major pattern of failure of ependymoma is local failure. The new treatment strategies are required to improve the probability of local control.