|
|
High failure rate in
spinal ependymomas with long-term follow-up
D. R. Gomez, B. T. Missett, W. M. Wara, D. A. Larson, P. K. Sneed, M. D.
Prados, S. M. Chang, M. S. Berger, N. Gupta, D. A. Haas-Kogan;
University of California-San Francisco, San Francisco, CA
Background.
Data on spinal ependymomas are sparse, and the prognostic
value of many clinical variables remains controversial.
The purpose of this study is to review a historical cohort of patients with
spinal cord ependymomas treated with post-operative radiotherapy and assess the
impact of extent of resection and radiation dose on progression-free survival
(PFS) and overall survival (OS).
We hoped the large patient number and long follow-up would lead to significant
and relevant conclusions about a relatively rare and indolent disease.
Methods.
Thirty-seven patients with primary spinal cord ependymomas
received postoperative radiation therapy from 1955-2001.
The influence of radiation dose (range 45-59.4 Gy), extent of resection, KPS,
tumor location, multifocality, and tumor grade was analyzed using the Cox
proportional hazards model.
Results.
With a median follow-up of 157 months (range 8-492), 5-, 10-,
and 15-year PFS rates are 75% ± 7.4%, 50% ± 9.1%, and 46% ± 9.3%,
respectively, while OS rates are 83% ± 6.2, 74% ± 7.5%, and 61% ± 8.5%,
respectively.
The median time to recurrence is 68 months, with 57% of failures occurring after
5 years.
Of the prognostic factors examined, only greater extent of resection
significantly correlated with longer PFS (P=0.001).
High-grade histology was associated with worse PFS in multivariate analysis
(P=0.027).
Conclusions.
Large patient numbers and long follow-up demonstrate that
local relapse rates for spinal ependymomas are higher than previously cited,
with a large proportion of failures occurring more than 5 years after
diagnosis.
Aggressive surgical resection correlates with improved outcome and we thus
recommend excision aimed at maximal resection while avoiding surgical
morbidity.
Regardless of the extent of resection, we recommend postoperative radiation to
doses of 50-54 Gy and extended, close follow-up.
Copyright 2004 American Society of Clinical Oncology All rights
reserved worldwide.
Source: http://www.asco.org/ac/1,1003,_12-002636-00_18-0026-00_19-001751,00.asp
|
