Combined treatment of fourth ventricle ependymomas: report of 26 cases

• Published in: Surgical neurology 2000-07, Vol.54 (1), p.19-26
• Main Authors: Spagnoli, Diego, Tomei, Giustino, Ceccarelli, Giovanni, Grimoldi, Nadia, Lanterna, Andrea, Bello, Lorenzo, Sinisi, Marco Michele, De Santis, Antonio, Villani, Roberto Matteo
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Brain Neoplasms - mortality; Brain Neoplasms - pathology; Brain Neoplasms - therapy; Child; Child, Preschool; classification; Combined Modality Therapy; Cranial Fossa, Posterior - radiation effects; Cranial Fossa, Posterior - surgery; Ependymoma; Ependymoma - mortality; Ependymoma - pathology; Ependymoma - therapy; Female; Follow-Up Studies; Fourth Ventricle - radiation effects; Fourth Ventricle - surgery; Humans; Infant; Male; Middle Aged; posterior fossa; Radiotherapy Dosage; Retrospective Studies; surgery; Survival Rate; Treatment Outcome; treatment results; World Health Organization (WHO)
• ISSN: 0090-3019; 1879-3339
• DOI: 10.1016/S0090-3019(00)00272-X

BACKGROUND This study investigated the relevance of prognostic factors and the impact of histological features in posterior fossa ependymoma. METHODS The charts of 26 patients (aged 1–59 years, mean 20.6 years; 11 adults) with posterior fossa ependymoma operated on between January 1983 and December 1994 were reviewed and patients followed up (mean: 93 months). RESULTS Gross total resection was performed in 18 patients (69%), subtotal in seven patients (27%), biopsy in one patient (4%). One patient (3.8%) developed respiratory complications and died. All patients underwent posterior fossa radiotherapy (5000 cGy) after surgery. Four children first received chemotherapy and then radiotherapy only when at least 3 years old. Eleven patients (42%) received radiotherapy and subsequently chemotherapy. The 5-year survival rate was 90% for adults and 40% for children (≤ 6 years). CONCLUSIONS This review suggests that a) younger patients (≤ 6 years), despite multimodality treatment, have a poor prognosis; b) the microanatomical location of the tumor (lateral recess, roof, and floor) influences the extent of tumor removal ( p < 0.05); c) longer survivals are associated with complete removal ( p < 0.05); d) the histological feature most often related to a poor prognosis is a high mitotic index ( p < 0.05), whereas vascular proliferation ( p = 0.149), necrosis ( p = 0.215), nuclear atypia ( p = 0.384) and high cellularity ( p = 0.786) do not affect survival; e) histological classification (WHO) does not reflect different survival rates between ependymomas and anaplastic ependymomas ( p = 0.082).