Artikel
Spinal ependymoma in adults: a multicenter retrospective study
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Autoren
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Maria Wostrack
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Germany
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Florian Ringel
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Germany
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Ehab Shiban
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Germany
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Victoria Kehl
- Institute for Medical Statistics and Epidemiology, Technical University of Munich
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Max Jägersberg
- Department of Neurosurgery, University of Geneva Medical Center, Switzerland
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Karl Schaller
- Department of Neurosurgery, University of Geneva Medical Center, Switzerland
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Sven Eicker
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf
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Claudius Thomé
- Department of Neurosurgery, Medical University Innsbruck, Austria
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Johannes Kerschbaumer
- Department of Neurosurgery, Medical University Innsbruck, Austria
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Peter Vajkoczy
- Department of Neurosurgery, Charité University, Berlin, Germany
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Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Germany
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Julia Onken
- Department of Neurosurgery, Charité University, Berlin, Germany
| Veröffentlicht: | 2. Juni 2015 |
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Gliederung
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Objective: Due to a relative low incidence of spinal ependymomas in adults, a definitive therapeutic strategy is still missing.
Method: We identified 158 cases of adult spinal ependymomas (83 male and 75 female patients, median age 45 years) treated surgically at five centers between 01/2006 and 06/2013. Current median follow-up (FU) is 19 months (range 1–127 months). Preoperative, early postoperative and follow-up clinical performance was evaluated according to the modified McCormick scale. Postoperative deterioration was dichotomized in “slight” (=deterioration without any increase of the modified McCormick scale grades or an increase in only one grade within the scale range 1–2) and "significant" (=increase to grade ≥3 or an increase in more than one grade on the modified McCormick scale). Age, sex, multifocal manifestation, tumour location, extent of resection, WHO grade, and tumour volume were assessed as possible predictive factors for tumor recurrence.
Results: 56 ependymomas were located in the cervical, 33 in the thoracic spinal cord, and 67 within lumbar and lumbosacral part. 16 patients presented with multifocal spinal lesions, 8 patients had recent or former cerebral ependymoma manifestation, and 2 patients disseminated disease at the time of the first diagnosis. Histology: 66% were WHO II°, 22% WHO°I, in 6% anaplastic WHO°III ependymoma was diagnosed. Gross total resection (GTR) was achieved in 80% of cases. At discharge, 37% of patients showed a worsening of symptoms. During FU, 76% showed at least preoperative status, and 41% improved. In 2% a permanent significant deterioration remained. Adjuvant radiotherapy was performed in 15 cases. Tumour progression was observed in 16 cases (median progression free survival (PFS) 118 months). A Cox regression analysis revealed GTR (p=0.012), WHO grade II (p=0.002), and small tumour volume (p=0.024) as favourable prognostic factors for PFS. Among incompletely resected ependymomas, adjuvant therapy had no statistically significant impact on PFS (p=0.850).
Conclusions: GTR appears to be the main column of ependymoma therapy and can be achieved in the majority of cases with an acceptable rate of neurological impairment. Small tumor volume and WHO°II are important prognostic factors for PFS within a short-term FU. The role of adjuvant treatment remains not unambiguously determined.
