gms | German Medical Science

Objective: Due to a low incidence of spinal ependymomas in adults, a definitive therapeutic strategy is still missing. Therefore, different concepts are under discussion without a uniform standard of therapy and diagnostics.

Method: A retrospective analysis of 41 consecutive patients (23 f, 18 m, median age 51 y) treated surgically between 03/2006 and 05/2012 at our department was performed. Tumor location: intramedullary n=22, cauda equina/filum terminale n=18, multifocal n=1. First follow-up (f/u) MRI and exam was done 3 months postop, afterwards every year in case of stable findings. Current median f/u is 29 months (range 3–72). Clinical status was evaluated according to the modified McCormick scale (mMS). Postop deterioration was dichotomized in “slight” (=no increase of the mMS grades or an increase in 1 grade within the scale range 1–2) and “significant” (=increase to grade ≥3 on the mMS).

Results: Preoperatively, the majority presented neurologically intact or with mild deficits maintaining functional independence according to the mMS. The most common preop symptom was pain (78%), followed by sensory deficits (54%), gait ataxia (34%), motor deficits (27%), and bowel/bladder dysfunction (12%). In 1 patient the ependymoma was found incidentally. Gross total resection (GTR) was achieved in 85% (n=35) (subtotal resection n=5, debulking n=1). Histology: WHO II° n=30, WHO°I n=10, WHO°III n=1. Immediately after surgery 24% (n=10) showed worsening (mostly mild new deficits). During follow-up 78% showed at least preop status, 37% improved. In only 5% (n=2) a permanent significant deterioration remained. Adjuvant radiotherapy (RT) was performed after the first surgery in 2 cases: in 1 patient with drop metastasis, and in 1 patient with multifocal lesions (both WHO°II). Tumour recurrence was seen in 4 cases, so far: 3 WHO°II, 1 WHO°I, 2 of them despite previous GTR and 1 despite adjuvant RT. Median progression free survival was 22 months (range 6–43). 2 patients died of meningeosis 19 and 31 months after the initial diagnosis, respectively.

Conclusions: GTR still stays the main column of ependymoma therapy. In our series this could be achieved in 85% accompanied by a rate of 5% for significant persistent deficits. In cases of incomplete resection stereotactic RT as well as a "wait and see" srategy can be considered. In case of disseminated disease holospinal RT with a boost to the primary tumour site is recommended. Due to the risk of recurrence, close follow-up examinations are mandatory.