Prognostic factors in intramedullary ependymomas
DOI:
https://doi.org/10.24265/horizmed.2021.v21n1.08Keywords:
Ependymoma, Intramedullary, Radiotherapy, Drug therapy, PrognosisAbstract
Objective: To study the good prognostic factors, overall survival (OS) and progression-free survival (PFS) in a group of patients who underwent an intramedullary ependymoma surgery. Such factors are related to the patient, tumor, type of surgical resection and adjunctive treatment. Materials and methods: A retrospective, analytical and descriptive study conducted in 40 patients who underwent an intramedullary ependymoma surgery between 1985 and 2017 at the Instituto Nacional de Enfermedades Neoplásicas (INEN). The research used IBM SPSS Statistics for Windows 2017. The survival rate was estimated using the Kaplan-Meier product-limit model. The comparison of survival curves was determined by the log-rank test. A probability (p value) less than 0.05 was considered as statistically significant. Results: Out of the 40 patients, 33 were adults and seven were children. The male to female ratio was 1.4:1. The most frequent symptom was motor deficit, which occurred in 97.50 % of the patients. The mean and median of the disease period were 24.90 and 19 months, respectively, with a range of 2 to 108 months. The condition occurred most frequently in the cervical (47.50 %) and lumbar (25 %) areas. Forty percent (40 %) of the patients developed syringomyelia. Concerning their size, 60 % of the tumors covered three to five levels, and 32.50 % were larger than five levels. Thirty percent (30 %), 60 % and 10 % of the patients underwent a total, subtotal and partial resection, respectively. Seventyseven point five zero percent (77.50 %) of the patients had grade II ependymoma, 15 % had grade I and 7.50 % had grade III. Thirty-three (33) patients (82.50 %) received radiotherapy (RTx) and three, chemotherapy (CTx). Overall survival accounted for 240 months. Age, sex, tumor size and disease were not statistically significant predictors of survival. Total resection showed survival rates of 100 %, 90 % and 90 % at 5, 10 and 15 years, respectively, and statistically significant differences in relation to partial and subtotal resections (p < 0.011). There were statistically significant differences in the group of patients who received radiotherapy (p < 0.002). Progression-free survival accounted for 168 months. There were statistically significant differences in the progression-free survival regarding total resection and adjuvant radiotherapy, but no differences in the other variables. A mild to moderate motor deficit improved life prognosis during postoperative and follow-up periods. Conclusions: Several factors affect overall survival and progression-free survival rates, with the most frequent being total resection and radiotherapy, and the least frequent a good preoperative motor function.
Downloads
References
Sun X-Y, Wang W, Zhang T-T, Kong C, Sun S-Y, Guo M-C, et al. Factors associated with postoperative outcomes in patients with intramedullary Grade II ependymoma. A Systematic review and meta-analysis. Medicine (Baltimore). 2019; 98(25): e16185.
Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, et al. The 2007 WHO classification of tumours of the Central Nervous System. Acta Neuropathol. 2007; 114(2): 97-109.
Louis DN, Ohgaki H, Wiestler OD, Cavenee WK. WHO Classification of Tumours of the Central Nervous System. 4th ed. IARC: Lyon; 2016.
Celano E, Salehani A, Malcolm JG, Reinertsen E, Hadjipanayis CG. Spinal cord ependymoma: a review of the literature and case series of ten patients. J Neurooncol. 2016; 128(3): 377-86.
Svoboda N, Bradac O, de Lacy P, Benes V. Intramedullary ependymoma: long-term outcome after surgery. Acta Neurochir (Wien). 2018; 160(3): 439-47.
Engelhard HH, Villano JL, Porter KR, Stewart AK, Barua M, Barker FG, et al. Clinical presentation histology and treatment in 430 patients with primary tumors of the spinal cords, spinal meninges, or cauda equina. J Neurosurg Spine. 2010; 13(1): 67-77.
Yuh EL, Barkovich AJ, Gupta N. Imaging of ependymomas: MRI and CT. Childs Nerv Syst. 2009; 25(10): 1203-13.
Klekamp J, Samii M. Syringomyelia, Diagnosis and Treatment. Berlín: Springer; 2001.
Klekamp J. Spinal ependymomas. Part I: Intramedullary ependymomas. Neurosurg Focus. 2015; 39 (2): E6.
Abdullah KG, Lubelski D, Miller J, Steinmetz MP, Shin JH, Krishnaney A, et al. Progression free survival and functional outcome after surgical resection of intramedullary ependimomas. J Clin Neurosci. 2015; 22(12): 1933-7.
Malis LI. Intramedullary spinal tumors cord. Clin Neurosurg. 1978; 25: 512-39.
Peschell RE, Kapp DS, Cardinale F, Manuelidis EE. Ependymoma of the spinal cords. Int J Radiotherapy Oncol Biol Phys. 1983; 9(7): 1093-6.
Shaw EG, Evans RG, Sceithauer BW, Ilstrup DM, Earle JD. Radiotherapeutic management of adults intraspinal ependymoma. J Radiother Oncol Biol Phys. 1986; 12(3): 323-7.
McCormick PC, Torres R, Post KD, Stein BM. Intramedullary ependymoma of the spinal cord. J Neurosurg. 1990; 72(4): 523-32.
Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958; 53(282): 457-81.
Gelabert-González M, Arcos-Algaba A, Serramito-García R, Castro-Bouzas D, Santín-Amo JM, Aran-Echabe E, et al. Ependimomas del filum terminal. Análisis de 20 casos consecutivos. Neurocirugía. 2010; 21(5): 381-9.
Mc Girt MJ, Chaichana KL, Atiba A, Attenello F, Yao KC, Jello GI. Resection of intramedullary spinal cords tumors in children: assessmet of long-term motor and sensory deficits. J Neurosurg Pediatr. 2008; 1(1): 63-7.
Rudà R, Reifenberger G, Frappaz D, Pfister SM, Laprie A, Santarius T, et al. EANO guidelines for the diagnosis and treatment of ependymal tumors. Neuro Oncol. 2018; 20(4): 445-56.
Eroes CA, Zausinger S, Kreth F-W, Goldbrunner R, Tonn J-C. Intramedullary low grade astrocytoma and ependymoma. Surgical results and predicting factors for clinical outcome. Acta Neurochir (Wien). 2010; 152(4): 611-8.
Wostrack M, Ringel F, Eicker SO, Jägersberg M, Schaller K, Kerschbaumer J, et al. Spinal ependymoma in adults: a multicenter investigation of surgical outcome and progression-free survival. J Neurosurg Spine. 2018; 28(6): 654-62.
Boström A, Von Lehe M, Hartmann W, Pietsch T, Feuss M, Boström JP, et al. Surgery for spinal cord ependymomas: outcome and prognostic factors. Neurosurgery. 2011; 68(2): 302-9.
Garcés-Ambrossi GL, Mc Girt MJ, Mehta VA, Sciubba DM, Witham TF, Bydon A, et al. Factors associated whit progression-free survival and long-term neurological outcome after resection of intramedullary spinal cord tumors: analysis of 101 consecutive cases. J Neurosurg Spine. 2009; 11(5): 591-9.
Ebner FH, Roser F, Falk M, Hermann S, Honegger J, Tatagiba M. Management of intramedullary spinal cord lesions: interdependence of the longitudinal extension of the lesion and the functional outcome. Eur Spine J. 2010; 19(4): 665-9.
Vera-Bolaños E, Aldape K, Yuan Y, Wu J, Wani K, Necesito-Reyes MJ, et al. Clinical course and progression-free survival of adults intracranial and spinal ependymomas patients. Neuro Oncol. 2015; 173(3): 440-7.
Adam Y, Benezech J, Blanquet A, Fuentes J-M, Bousigue J-Y, Debono B, et al. Intramedullary tumors. Results of a national investigation in private neurosurgery. Neurochirurgie. 2010; 56(4): 344-9.
Aghakhani N, David P, Parker F, Lacroix C, Benoudiva F, Tadie M. Intramedullary spinal ependymoma: analisys of consecutive series of 82 adult cases with particular attention to patients with no preoperative neurological deficit. Neurosurg. 2008; 62(6): 1279-85.
Kucia EJ, Bambakidis NC, Chang SW, Spetzler RF. Surgical technique and outcomes in the treatment and spinal cord ependymoma, part 1: intramedullary ependymomas. Neurosurgery. 2011; 68(Suppl. 1): 57-63.
Lee S-M, Cho Y-E, Kwon Y-M. Neurological outcome after surgical treatment of intramedullary spinal cords tumors. Korean J Spine. 2014; 11(3): 121-6.
Li T-Y, Chu J-S, Xu Y-L, Yang J, Wang J, Huang Y-H, et al. Surgical strategies and outcomes of spinal ependymomas of different lengths: analysis of 210 patients. J Neurosurg Spine. 2014; 21(2): 249-59.
Manzano G, Green BA, Vanni S, Levi AD. Contemporary management of adult pathology and neurological outcome related to surgical resection. Spinal Cord. 2008; 46(8): 540-6.
Sun X-Y, Kong C, Lu S-B, Sun S-Y, Guo M-C, Ding J-Z. Survival outcomes and prognostic factors of patients with intramedullary Grade II ependymomas after surgical treatments. J Clin Neurosci. 2018; 57: 136-42.
Hanbali F, Fourney DR, Marmor E, Suki D, Rhines LD, Weinberg JS, et al. Spinal cord ependymoma: radical surgery resection and outcome. Neurosurgery. 2002; 51(5): 1172-4.
Oh MC, Kim JM, Kaur G, Safaee M, Sun MZ, Singh A, et al. Prognosis by tumor location in adults with spinal ependymomas. J Neurosurg Spine. 2013; 18(3): 226-35.
Tobin MK, Geraghty JR, Engelhard HH, Linninger AA, Mehta AI. Intramedullary spinal cord tumors: a review of current and future treatment strategies. Neurosurg Focus. 2015; 39 (2): E14.
Lee S-H, Chung CK, Kim CH, Yoon SH, Hyun S-J, Kim K-J, et al. Long-term outcomes of surgical resection with or without adjuvant radiation therapy for treatment of spinal ependymoma: a retrospective multicenter study by the Korea Spinal Oncology Research Group. Neuro Oncol. 2013; 15(7): 921-9.
Clover LL, Hazuka MB, Kinzie JJ. Spinal cord ependymomas treated with surgery and radiation therapy. A review of 11 cases. Am J Clin Oncol. 1993; 16(4): 350-3.
Wen BC, Hussey DH, Hitchon PW, Schelper RL, Vigliotti AP, Doornbos JF, et al. The role radiation therapy in the management of ependymomas of the spinal cord. Int J Radiat Oncol Biol Phys. 1991; 20(4): 781-6.
Dulai MS, Caccamo DV, Briley AL, Edwards MSB, Fisher PG, Lehman NL. Intramedullary papillary ependymoma with chordoid plexus differentiation and cerebrospinal fluid dissemination to the brain. J Neurosurg Pediatric. 2010; 5(5): 511-7.
Chamberlain MC. Salvage chemotherapy for recurrent spinal cord ependymoma. Cancer. 2002; 95(5): 997-1002
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Horizonte Médico (Lima)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Horizonte Médico (Lima) (Horiz. Med.) journal’s research outputs are published free of charge and are freely available to download under the open access model, aimed at disseminating works and experiences developed in biomedical and public health areas, both nationally and internationally, and promoting research in the different fields of human medicine. All manuscripts accepted and published in the journal are distributed free of charge under the terms of a Creative Commons license – Attribution 4.0 International (CC BY 4.0).
