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Journal of Neuro-Oncology

, Volume 80, Issue 2, pp 177–183 | Cite as

Spinal myxopapillary ependymoma outcomes in patients treated with surgery and radiotherapy at M.D. Anderson Cancer Center

  • Serap Akyurek
  • Eric L. ChangEmail author
  • Tse-Kuan Yu
  • Darrin Little
  • Pamela K. Allen
  • Ian McCutcheon
  • Anita Mahajan
  • Moshe H. Maor
  • Shiao Y. Woo
Original Paper

Abstract

This study was undertaken to determine the disease outcomes in patients treated with surgery alone or surgery and adjuvant radiotherapy (RT) for myxopapillary ependymoma (MPE) of the spine. The medical records of 35 patients with MPE treated at The University of Texas M.D. Anderson Cancer Center between December 1968 and July 2002 were reviewed. The endpoints analyzed were progression-free survival (PFS), overall survival, and local control. The median age of patients was 35 years (range, 14–63 years), and the male to female ratio was 2.5:1. In total, 21 (60%) patients underwent a gross total resection, 13 (37%) a subtotal resection, and 1 (3%) a biopsy only; 22 of them (63%) also received adjuvant RT. The median follow-up was 10.7 years. The 10-year overall survival, PFS, and local control rates for the entire group were 97%, 62%, and 72%, respectively. Of 11 patients 5 (45%) who had undergone gross total resection alone had recurrence. A total of 12 (34%) patients had disease recurrence, all in the neural axis; 8 of them had treatment failure at the primary site only, 3 in the distant neural axis only, and 1 at the primary site and in the distant neural axis. Patient age (> 35 years; P = 0.002) and adjuvant RT (P = 0.04) significantly affected PFS. The long-term patient survival duration for MPE managed with surgery and adjuvant RT is favorable. Regardless of the extent of resection, adjuvant RT appears to significantly reduce the rate of tumor progression. Failures occurred exclusively in the neural axis, mainly at the primary site.

Keywords

Myxopapillary ependymoma Ependymoma Spinal tumor Surgery Radiotherapy 

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References

  1. 1.
    Damjanov I, Linder J (eds) (1996) Anderson’s pathology, 10th edn. S Mosby, St. Louis, pp 2753–2755Google Scholar
  2. 2.
    Peschel RE, Kapp DS, Cardinale F, Manuelidis EE (1983) Ependymomas of the spinal cord. Int J Radiat Oncol Biol Phys 9:1093–1096PubMedGoogle Scholar
  3. 3.
    Shuman RM, Alvord EC, Leech RW (1975) The biology of childhood ependymomas. Arch Neurol 32:731–739PubMedGoogle Scholar
  4. 4.
    Kernohan JW (1932) Primary tumors of the spinal cord and intradural filum terminale. In: Penfield W (ed). Cytology and cellular pathology of the nervous system, vol 3. Paul B. Hoeber, New York, pp 993–1025Google Scholar
  5. 5.
    Gilhuis HJ, van der Laak J, Wesseling P, Boerman RH, Beute G, Teepen JLMJ, Grotenhuis JA, Kappelle AC (2004) Inverse correlation between genetic aberrations and malignancy grade in ependymal tumors: a paradox? J Neurooncol 66:111–116PubMedCrossRefGoogle Scholar
  6. 6.
    Hirose Y, Aldape K, Bollen A, James CD, Brat D, Lamborn K, Berger M, Feuerstein BG (2001) Chromosomal abnormalities subdivide ependymal tumors into clinically relevant groups. Am J Pathol 158:1137–1143PubMedGoogle Scholar
  7. 7.
    Kleihues P, Cavenee WK (eds). (2000) Pathology and genetics of tumours of the central nervous system, 2nd edn. IARC Press, Lyon, FranceGoogle Scholar
  8. 8.
    Available from URL://www.cancer.gov/pdq/treatment/adultbrain/healthprofessional [accessed November, 17, 2005]Google Scholar
  9. 9.
    Sonneland PR, Scheithauer BW, Onofrio BM (1985) Myxopapillary ependymoma. A clinicopathologic and immunohistochemical study of 77 cases. Cancer 56:883–893PubMedCrossRefGoogle Scholar
  10. 10.
    Sato H, Ohmura K, Mizushima M, Ito J, Kuyama H (1983) Myxopapillary ependymoma of the lateral ventricle: a study on the mechanism of its stromal myxoid change. Acta Pathol Jpn 33:1017–1025PubMedGoogle Scholar
  11. 11.
    Yu YL, Crockard HA, Smith JJ, Harries BJ (1982) Extraspinal ependymoma at the cervicothoracic junction. Surg Neurol 17:160–162PubMedCrossRefGoogle Scholar
  12. 12.
    Maruyama R, Koga K, Nakahara T, Kishida K, Nabeshima K (1992) Cerebral myxopapillary ependymoma. Hum Pathol 23:960–962PubMedCrossRefGoogle Scholar
  13. 13.
    Helwig EB, Stern JB (1984) Subcutaneous sacrococcygeal myxopapillary ependymoma. A clinicopathologic study of 32 cases. Am J Clin Pathol 81:156–161PubMedGoogle Scholar
  14. 14.
    Schild SE, Nisli K, Scheithauer BW, Wong WW, Lyons MK, Schomberg PJ, Shaw EG (1998) The results of radiotherapy for ependymoma: the Mayo Clinic experience. Int J Radiat Oncol Biol Phys 42:953–958PubMedCrossRefGoogle Scholar
  15. 15.
    Schwartz TH, McCormick PC (2000) Intramedullary ependymomas: clinical presentation, surgical treatment strategies and prognosis. J Neurooncol 47:211–218PubMedCrossRefGoogle Scholar
  16. 16.
    Whitaker SJ, Bessell EM, Ashey SE, Bloom HJ, Bell BA, Brada M (1991) Postoperative radiotherapy in the management of spinal cord ependymoma. J Neurosurg 74:720–728PubMedCrossRefGoogle Scholar
  17. 17.
    Yoshii S, Shimizu K, Ido K, Nakamura T (1999) Ependymoma of the spinal cord and the cauda equina region. J Spinal Disord 12:157–161PubMedCrossRefGoogle Scholar
  18. 18.
    Waldron JN, Laperriere NJ, Jaakkimainen L, Simpson WJ, Payne D, Milosevic M, Wong CS (1993) Spinal cord ependymomas: a retrospective analysis of 59 cases. Int J Radiat Oncol Biol Phys 27:223–229PubMedGoogle Scholar
  19. 19.
    Hanbali F, Fourney DR, Marmor E, Suki D, Rhines LD, Weinberg JS, McCutcheon IE, Suk I, Gokaslan ZL (2002) Spinal cord ependymoma: radical surgical resection and outcome. Neurosurgery 51:1162–1174PubMedCrossRefGoogle Scholar
  20. 20.
    Sgouros S, Malluci CL, Jackowski A (1996) Spinal ependymomas the value of postoperative radiotherapy for residual disease control. Br J Neurosurg 10:559–566PubMedCrossRefGoogle Scholar
  21. 21.
    Lin YH, Huang CI, Wong TT, Chen MH, Shiau CY, Wang LW, Ho DMT, Yen SH (2005) Treatment of spinal cord ependymomas by surgery with or without postoperative radiotherapy. J Neurooncol 71:205–210PubMedCrossRefGoogle Scholar
  22. 22.
    Cooper PR, Ebstein F (1985) Radical resection of intramedullary spinal cord tumors in adults. Recent experience in 29 patients. J Neurosurg 63:492–499PubMedGoogle Scholar
  23. 23.
    McCormick PC, Torres R, Post KD, Stein BM (1990) Intramedullary ependymoma of spinal cord. J Neurosurg 72:523–532PubMedCrossRefGoogle Scholar
  24. 24.
    Frankel HL, Hancock D, Hyslop G, Melzak J, Michaelis LS, Ungar GH, Vernon JD, Walsh JJ (1969) The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. Paraplegia 24:179–192Google Scholar
  25. 25.
    Shaw EG, Evans RG, Scheithauer BW, Ilstrup DM, Earle JD (1986) Radiotherapeutic management of adult intraspinal ependymomas. Int J Radiat Oncol Biol Phys 12:323–327PubMedGoogle Scholar
  26. 26.
    Clover LL, Mark BH, Kinzie JJ (1993) Spinal cord ependymomas treated with surgery and radiation therapy. Am J Clin Oncol 16:350–353PubMedGoogle Scholar
  27. 27.
    Wen BC, Hussey DH, Hitchon PW, Schelper RL, Vigliotti AP, Doornbos JF, Van Gilder JC (1991) The role of radiation therapy in the management of ependymomas of the spinal cord. Int J Radiat Oncol Biol Phys 20:781–786PubMedGoogle Scholar
  28. 28.
    Fisher G, Mansuy L (1980) Total removal of intramedullary ependymomas: follow-up study of 16 cases. Surg Neurol 14:243–249Google Scholar
  29. 29.
    Kopelson G, Linggood RM, Kleinman GM, Doucette J, Wang CC (1980) Management of intramedullary spinal cord tumors. Radiology 13:473–479Google Scholar
  30. 30.
    Lee TT, Gromelski EB, Green BA (1998) Surgical treatment of spinal ependymoma and post-operative radiotherapy. Acta Neurochir (Wien) 140:309–313CrossRefGoogle Scholar
  31. 31.
    Hoshimaru M, Koyama T, Hashimoto N, Kikuchi H (1999) Results of microsurgical treatment for intramedullary spinal cord ependymomas: analysis of 36 cases. Neurosurgery 44:264–269PubMedCrossRefGoogle Scholar
  32. 32.
    Marks JE, Adler SJ (1982) A comparative study of ependymomas by site of origin. Int J Radiat Oncol Biol Phys 8:73–83Google Scholar
  33. 33.
    Garcia DM (1985) Primary spinal cord tumors treated with surgery and postoperative irradiation. Int J Radiat Oncol Biol Phys 11:1933–1939PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2006

Authors and Affiliations

  • Serap Akyurek
    • 1
    • 2
  • Eric L. Chang
    • 1
    Email author
  • Tse-Kuan Yu
    • 1
  • Darrin Little
    • 1
  • Pamela K. Allen
    • 1
  • Ian McCutcheon
    • 3
  • Anita Mahajan
    • 1
  • Moshe H. Maor
    • 1
  • Shiao Y. Woo
    • 1
  1. 1.Department of Radiation OncologyThe University of Texas M.D. Anderson Cancer CenterHoustonUSA
  2. 2.Department of Radiation OncologyAnkara University School of MedicineAnkaraTurkey
  3. 3.Department of NeurosurgeryThe University of Texas M.D. Anderson Cancer CenterHoustonUSA

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