Skip to main content
Log in

Supratentorial gross-totally resected non-anaplastic ependymoma: population based patterns of care and outcomes analysis

  • Clinical Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Observation following gross-total resection (GTR) for non-anaplastic supratentorial ependymomas is often advocated based on small, retrospective series. The purpose of this study is to perform a population-based analysis to examine outcomes for this rare cohort of low-risk patients. A retrospective analysis was conducted utilizing the Surveillance, Epidemiology and End Results Program of the United States National Cancer Institute. We identified patients with supratentorial non-anaplastic ependymoma who underwent GTR alone or GTR followed by radiation. We identified 92 patients who met these criteria. The median age was 17.5 years (range 1–83) with the majority female (58 %) and white (75 %). Radiotherapy (RT) was delivered in half of patients. The 5-/10-year Kaplan–Meier estimated overall survival (OS) and cause-specific survival (CSS) for the overall cohort was 83.2/71.4 and 84.1/78.0 %, respectively. There was no evidence of decreased CSS (HR 0.52 [0.18–1.51]; p = 0.23) or OS (HR 0.63 [0.25–1.59]; p = 0.33) with the omission of RT on univariate analysis. Age ≥18 years correlated with worse OS (HR 4.01 [1.45–11.11]; p = 0.008) and CSS (HR 2.86 [0.99–8.31]; p = 0.05). RT did not impact outcome for this low-risk cohort of patients. Older age correlates with poor prognosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bailey P, Cushing H (1926) A classification of the tumors of the glioma group on a histogenetic basis with a correlated study of prognosis. JB Lippincott, Philadelphia

    Google Scholar 

  2. Rodriguez D, Cheung MC, Housri N, Quinones-Hinojosa A, Camphausen K, Koniaris LG (2009) Outcomes of malignant CNS ependymomas: an examination of 2408 cases through the surveillance, epidemiology, and end results (SEER) database (1973–2005). J Surg Res 156(2):340–351

    Article  PubMed  Google Scholar 

  3. Louis DN, Ohgaki H, Wiestler OD et al (2007) The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 114(2):97–109

    Article  PubMed  Google Scholar 

  4. Coulon RA, Till K (1977) Intracranial ependymomas in children: a review of 43 cases. Childs Brain 3(3):154–168

    PubMed  CAS  Google Scholar 

  5. Mork SJ, Loken AC (1977) Ependymoma: a follow-up study of 101 cases. Cancer 40(2):907–915

    Article  PubMed  CAS  Google Scholar 

  6. Papadopoulos DP, Giri S, Evans RG (1990) Prognostic factors and management of intracranial ependymomas. Anticancer Res 10(3):689–692

    PubMed  CAS  Google Scholar 

  7. Sutton LN, Goldwein J, Perilongo G et al (1990) Prognostic factors in childhood ependymomas. Pediatr Neurosurg 16(2):57–65

    Article  PubMed  Google Scholar 

  8. Rousseau P, Habrand JL, Sarrazin D et al (1994) Treatment of intracranial ependymomas of children: review of a 15-year experience. Int J Radiat Oncol Biol Phys 28(2):381–386

    Article  PubMed  CAS  Google Scholar 

  9. Perilongo G, Massimino M, Sotti G et al (1997) Analyses of prognostic factors in a retrospective review of 92 children with ependymoma: Italian Pediatric Neuro-oncology Group. Med Pediatr Oncol 29(2):79–85

    Article  PubMed  CAS  Google Scholar 

  10. Rogers L, Pueschel J, Spetzler R et al (2005) Is gross-total resection sufficient treatment for posterior fossa ependymomas? J Neurosurg 102(4):629–636

    Article  PubMed  Google Scholar 

  11. Swanson EL, Amdur RJ, Morris CG et al (2011) Intracranial ependymomas treated with radiotherapy: long-term results from a single institution. J Neurooncol 102(3):451–457

    Article  PubMed  CAS  Google Scholar 

  12. Merchant TE, Li C, Xiong X, Kun LE, Boop FA, Sanford RA (2009) Conformal radiotherapy after surgery for paediatric ependymoma: a prospective study. Lancet Oncol 10(3):258–266

    Article  PubMed  Google Scholar 

  13. Horn B, Heideman R, Geyer R et al (1999) A multi-institutional retrospective study of intracranial ependymoma in children: identification of risk factors. J Pediatr Hematol Oncol 21(3):203–211

    Article  PubMed  CAS  Google Scholar 

  14. Ernestus RI, Wilcke O, Schroder R (1989) Intracranial ependymomas: prognostic aspects. Neurosurg Rev 12(2):157–163

    Article  PubMed  CAS  Google Scholar 

  15. Salazar OM, Castro-Vita H, VanHoutte P, Rubin P, Aygun C (1983) Improved survival in cases of intracranial ependymoma after radiation therapy late report and recommendations. J Neurosurg 59(4):652–659

    Article  PubMed  CAS  Google Scholar 

  16. Schild SE, Nisi K, Scheithauer BW et al (1998) The results of radiotherapy for ependymomas: the mayo clinic experience. Int J Radiat Oncol Biol Phys 42(5):953–958

    Article  PubMed  CAS  Google Scholar 

  17. Merchant TE, Kiehna EN, Li C, Xiong X, Mulhern RK (2005) Radiation dosimetry predicts IQ after conformal radiation therapy in pediatric patients with localized ependymoma. Int J Radiat Oncol Biol Phys 63(5):1546–1554

    Article  PubMed  Google Scholar 

  18. Conklin HM, Li C, Xiong X, Ogg RJ, Merchant TE (2008) Predicting change in academic abilities after conformal radiation therapy for localized ependymoma. J Clin Oncol 26(24):3965–3970

    Article  PubMed  Google Scholar 

  19. Hukin J, Epstein F, Lefton D, Allen J (1998) Treatment of intracranial ependymoma by surgery alone. Pediatr Neurosurg 29(1):40–45

    Article  PubMed  CAS  Google Scholar 

  20. Palma L, Celli P, Mariottini A, Zalaffi A, Schettini G (2000) The importance of surgery in supratentorial ependymomas. Long-term survival in a series of 23 cases. Childs Nerv Syst 16(3):170–175

    Article  PubMed  CAS  Google Scholar 

  21. Zacharoulis S, Ashley S, Moreno L, Gentet JC, Massimino M, Frappaz D (2010) Treatment and outcome of children with relapsed ependymoma: a multi-institutional retrospective analysis. Childs Nerv Syst 26(7):905–911

    Article  PubMed  Google Scholar 

  22. McGuire CS, Sainani KL, Fisher PG (2009) Both location and age predict survival in ependymoma: a SEER study. Pediatr Blood Cancer 52(1):65–69

    Article  PubMed  Google Scholar 

  23. McGuire CS, Sainani KL, Fisher PG (2009) Incidence patterns for ependymoma: a surveillance, epidemiology, and end results study. J Neurosurg 110(4):725–729

    Article  PubMed  Google Scholar 

  24. Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence—SEER 18 Regs Research Data, Nov 2011 Sub (1973–2009) (Katrina/Rita Population Adjustment)—Linked to County Attributes—Total U.S., 1969–2010 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released April 2012, based on the November 2011 submission

  25. Surveillance, Epidemiology, and End Results (SEER) Program Web site. Overview of the SEER Program. Available at http://seer.cancer.gov/about. Accessed July 2, 2012.

  26. Surveillance, Epidemiology and End Results (SEER) Program: Quality Improvement Process. Available from URL: http://seer.cancer.gov/qi/process.html. Accessed July 7, 2012.

  27. Metellus P, Figarella-Branger D, Guyotat J et al (2008) Supratentorial ependymomas: prognostic factors and outcome analysis in a retrospective series of 46 adult patients. Cancer 113(1):175–185

    Article  PubMed  Google Scholar 

  28. Young RF, Yoshimori RN, Murray DL, Chou PJ (1982) Postoperative neurosurgical infections due to bacillus species. Surg Neurol 18(4):271–273

    Article  PubMed  CAS  Google Scholar 

  29. Goldwein JW, Leahy JM, Packer RJ et al (1990) Intracranial ependymomas in children. Int J Radiat Oncol Biol Phys 19(6):1497–1502

    Article  PubMed  CAS  Google Scholar 

  30. Stuben G, Stuschke M, Kroll M, Havers W, Sack H (1997) Postoperative radiotherapy of spinal and intracranial ependymomas: analysis of prognostic factors. Radiother Oncol 45(1):3–10

    Article  PubMed  CAS  Google Scholar 

  31. Shaw EG, Evans RG, Scheithauer BW, Ilstrup DM, Earle JD (1986) Radiotherapeutic management of adult intraspinal ependymomas. Int J Radiat Oncol Biol Phys 12(3):323–327

    Article  PubMed  CAS  Google Scholar 

  32. Paulino AC, Wen BC (2000) The significance of radiotherapy treatment duration in intracranial ependymoma. Int J Radiat Oncol Biol Phys 47(3):585–589

    Article  PubMed  CAS  Google Scholar 

  33. Combs SE, Kelter V, Welzel T et al (2008) Influence of radiotherapy treatment concept on the outcome of patients with localized ependymomas. Int J Radiat Oncol Biol Phys 71(4):972–978

    Article  PubMed  Google Scholar 

  34. Merchant TE, Mulhern RK, Krasin MJ et al (2004) Preliminary results from a phase II trial of conformal radiation therapy and evaluation of radiation-related CNS effects for pediatric patients with localized ependymoma. J Clin Oncol 22(15):3156–3162

    Article  PubMed  Google Scholar 

  35. Spiegler BJ, Bouffet E, Greenberg ML, Rutka JT, Mabbott DJ (2004) Change in neurocognitive functioning after treatment with cranial radiation in childhood. J Clin Oncol 22(4):706–713

    Article  PubMed  Google Scholar 

  36. McLaughlin MP, Marcus RB Jr, Buatti JM et al (1998) Ependymoma: results, prognostic factors and treatment recommendations. Int J Radiat Oncol Biol Phys 40(4):845–850

    Article  PubMed  CAS  Google Scholar 

  37. Mansur DB, Perry A, Rajaram V et al (2005) Postoperative radiation therapy for grade II and III intracranial ependymoma. Int J Radiat Oncol Biol Phys 61(2):387–391

    Article  PubMed  Google Scholar 

  38. Marks JE, Adler SJ (1982) A comparative study of ependymomas by site of origin. Int J Radiat Oncol Biol Phys 8(1):37–43

    Article  PubMed  CAS  Google Scholar 

  39. Schwartz TH, Kim S, Glick RS et al (1999) Supratentorial ependymomas in adult patients. Neurosurgery 44(4):721–731

    Article  PubMed  CAS  Google Scholar 

  40. Merchant TE, Jenkins JJ, Burger PC et al (2002) Influence of tumor grade on time to progression after irradiation for localized ependymoma in children. Int J Radiat Oncol Biol Phys 53(1):52–57

    Article  PubMed  Google Scholar 

  41. Armstrong TS, Vera-Bolanos E, Bekele BN, Aldape K, Gilbert MR (2010) Adult ependymal tumors: prognosis and the M. D. Anderson Cancer Center experience. Neuro Oncol 12(8):862–870

    Article  PubMed  Google Scholar 

  42. Reni M, Brandes AA, Vavassori V et al (2004) A multicenter study of the prognosis and treatment of adult brain ependymal tumors. Cancer 100(6):1221–1229

    Article  PubMed  Google Scholar 

  43. Guirguis LM, Yang JC, White DE et al (2002) Safety and efficacy of high-dose interleukin-2 therapy in patients with brain metastases. J Immunother 25(1):82–87

    Article  PubMed  CAS  Google Scholar 

  44. Nazzaro JM, Neuwelt EA (1990) The role of surgery in the management of supratentorial intermediate and high-grade astrocytomas in adults. J Neurosurg 73(3):331–344

    Article  PubMed  CAS  Google Scholar 

  45. Lacroix M, Abi-Said D, Fourney DR et al (2001) A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg 95(2):190–198

    Article  PubMed  CAS  Google Scholar 

  46. Taylor RE (2004) Review of radiotherapy dose and volume for intracranial ependymoma. Pediatr Blood Cancer 42(5):457–460

    Article  PubMed  Google Scholar 

  47. Geyer JR, Sposto R, Jennings M et al (2005) Multiagent chemotherapy and deferred radiotherapy in infants with malignant brain tumors: a report from the Children’s Cancer Group. J Clin Oncol 23(30):7621–7631

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Amol J. Ghia.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (EPS 989 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ghia, A.J., Mahajan, A., Allen, P.K. et al. Supratentorial gross-totally resected non-anaplastic ependymoma: population based patterns of care and outcomes analysis. J Neurooncol 115, 513–520 (2013). https://doi.org/10.1007/s11060-013-1254-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-013-1254-8

Keywords

Navigation