Intracranial ependymoma in adult patients: results of postoperative radiotherapy

A i m. to evaluate the results of postoperative radiotherapy in patients with intracranial ependymoma. Material and methods . Twenty-four adult patients with intracranial ependymoma were treated between 1985 and 1998 with postoperative radiotherapy. Eighteen received craniospinal irradiation (median dose 30 Gy). The median dose given to the primary site was 57.6 Gy. The tumours were supratentorial in 13 (54%) and infratentorial in 11 (46%) patients. There were 6 anaplastic and 18 low-grade ependymomas. No patient received chemotherapy as the primary treatment. Pattern of failure, overall survival (OS), disease free survival (DFS) and survival after recurrence (SAR) were analysed. Age, tumour location, histology, extent of resection, performance and neurologic status were included in a univariate analysis in order to assess possible factors influencing overall survival. Results . Median follow up for alive patients was 93 months. Actuarial 3-, 5- and 10-year OS rates were 67%, 56% and 41%, respectively. Actuarial 3-, 5- and 10-year DFS rates were 62%, 48% and 48%, respectively. In the univariate analysis age was the strongest prognostic factor. Five-year OS for patients younger than 35 years was 92%, whilst for older ones it was 18%, p=0.0003. Better OS was observed in patients with intraventricular rather than extraventricular tumours (77% vs. 0%, p=0.01). The tendency towards improved OS was observed for infratentorial tumour location. Patients with infratentorial tumours survived 5 years in 72%, whilst those with supratentorial tumors only in 42%, p=0.17. Five-year survival for patients undergoing complete vs. incomplete resection was 0% vs. 74%, p=0.03. Histology, performance and neurologic status had no significant influence on OS. Tumour recurrence was observed in 12 (50%) patients. All recurrences were local. Two patients had simultaneous local and distant failure. Mean SAR was 26 months. SAR was longer for patients with failure occurring later (>1 year vs.≤1 year) after initial treatment (33 vs. 13 months). Conclusions . Local recurrence is the most frequent site of failure in patients with intracranial ependymoma. Patient age is a strong prognostic factor. Extraventricular location of ependymoma in adults worsens survival. Patients with anaplastic ependymoma and those with incompletely resected tumours have a relatively good prognosis after irradiation, an important part of treatment. WyEcio∏czak wewnatrzczaszkowy u doros∏ych: wyniki pooperacyjnego napromieniania Cel pracy . Ocena wynikow pooperacyjnej radioterapii 24 doros∏ych chorych na wewnatrzczaszkowego wyEcio∏czaka. Materia∏ i m etoda . Poddano analizie 24 chorych na wewnatrzczaszkowego wyEcio∏czaka, leczonych pooperacyjnym napromienianiem w II Zak∏adzie Teleradioterapii Centrum Onkologii im. M. Sk∏odowskiej-Curie, w latach 1985-1998. Osiemnastu chorych napromieniono na oE mozgowo-rdzeniowa (mediana dawki 30 Gy). Mediana dawki na guz lub lo˝´ wynios∏a 57,6 Gy. TrzynaEcie (54%) guzow po∏o˝onych by∏o nadnamiotowo, 11 (46%) podnamiotowo. Leczono 6 anaplastycznych oraz 18 ∏agodnych wyEcio∏czakow. Chorym nie podawano chemioterapii jako pierwotnego leczenia. Przeprowadzono analiz´ niepowodzeƒ leczenia, prze˝ycia ogolnego, prze˝ycia bez nawrotu choroby i prze˝ycia po wznowie (PPW). Oceny czynnikow