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Long-term outcomes of spinal ependymomas: an institutional experience of more than 60 cases

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Abstract

Purpose

Spinal ependymomas represent the most common primary intramedullary tumors for which optimal management remains undefined. When possible, gross total resection (GTR) is often the mainstay of treatment, with consideration of radiotherapy (RT) in cases of residual or recurrent tumor. The impact of extent of resection and radiotherapy remain understudied.

Objective

Report on a large institutional cohort with lengthy follow-up to provide information on long-term outcomes and to contribute to limited data assessing the value of extent of resection and RT.

Methods

Patients with pathologically proven primary spinal ependymoma between 1990 and 2018 were identified. Kaplan-Meier estimates were used to calculate progression-free survival (PFS); local-control (LC) and overall survival (OS). Logistic regression was used to analyze variables’ association with receipt of RT.

Results

We identified 69 patients with ependymoma of which 4 had leptomeningeal dissemination at diagnosis and were excluded. Of the remaining cohort (n = 65), 42 patients (65%) had Grade II spinal ependymoma, 20 (31%) had Grade I myxopapillary ependymoma and 3 (5%) had Grade III anaplastic ependymoma; 54% underwent GTR and 39% underwent RT. With a median follow-up of 5.7 years, GTR was associated with improved PFS. For grade II lesions, STR+RT yielded better outcomes than STR alone (10y PFS 77.1% vs 68.2%, LC 85.7% vs 50%). Degree of resection was the only significant predictor of adjuvant radiotherapy (p < 0.0001).

Conclusion

Our findings confirm the importance of GTR in spinal ependymomas. Adjuvant RT should be utilized in the setting of a subtotal resection with expectation of improved disease-related outcomes.

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Data Availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Radiation Oncology, Northwestern Lou and Jean Malnati Brain Tumor Institute, Northwestern University Robert H. Lurie Comprehensive Cancer Center, 676 N. St Clair Street, Suite 1820, Chicago, IL, 60611, USA

    Rohan Savoor, Timothy L. Sita, John A. Kalapurakal, Maryanne H. Marymont, Timothy J. Kruser & Sean Sachdev

  2. Department of Neurological Surgery, Northwestern Lou and Jean Malnati Brain Tumor Institute, Northwestern University Robert H. Lurie Comprehensive Cancer Center, 676 N. St Clair Street, Suite 2200, Chicago, IL, 60611, USA

    Nader S. Dahdaleh, Tyler Koski & Aruna Ganju

  3. Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA

    Irene Helenowski

  4. Department of Neurology, Northwestern University Feinberg School of Medicine, 710 N. Lake Shore Dr, Abbott Hall 1114, Chicago, IL, 60611, USA

    Rimas Lukas

  5. Department of Neurological Surgery, Oklahoma University School of Medicine, 1000 N. Lincoln Blvd. Suite 4000, Oklahoma City, OK, 73104, USA

    Zachary A. Smith

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  1. Rohan Savoor
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All authors participated in the writing and editing of the manuscript.

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Correspondence to Sean Sachdev.

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Northwestern University IRB: STU00209605.

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Savoor, R., Sita, T.L., Dahdaleh, N.S. et al. Long-term outcomes of spinal ependymomas: an institutional experience of more than 60 cases. J Neurooncol 151, 241–247 (2021). https://doi.org/10.1007/s11060-020-03658-7

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