SPINAL-CORD EPENDYMOMAS - A RETROSPECTIVE ANALYSIS OF 59 CASES

Purpose: To determine the outcome of patients with primary spinal epen dymoma treated with postoperative radio-therapy and to identify clinic al and treatment variables predictive of outcome. Methods and Material s: A retrospective chart review was undertaken of 59 spinal ependymoma patients referred to the Princess Margaret Hospital between 1958 and 1987. All patients were treated with radiation therapy to either the s ite of the primary tumor or the craniospinal axis. There were 23 femal e and 36 male patients with a median age of 37 years (range: 8-66 year s). Median follow-up was 130 months (range: 1-371 months). Clinical va riables including age, sex, length of symptoms, functional status, tum or location, and grade as well as treatment variables including extent of surgery, radiation dose and treatment volume were analyzed for inf luence on outcome. Results: Treatment was well-tolerated with no cases of radiation myelopathy identified. Overall actuarial survival at 5 a nd 10 years was 83% and 75%, respectively. Eleven patients had recurre nt tumor with the 9/11 having a component of their recurrence within t he treatment field. Median time to recurrence was 2 years with 9 of th e 11 recurrences within the first 3 years. Tumor grade was the only in dependent variable identified as predictive of outcome. Patients with well differentiated tumors had a 5-year cause-specific survival of 97% compared to 71% for those with intermediate or poorly differentiated tumors (p = 0.005). Conclusion: We conclude that postoperative irradia tion for patients with spinal ependymomas is associated with a favorab le outcome and that tumor grade is a major prognostic factor. Based on results of this series and a review of the literature, specific manag ement recommendations are made for this rare tumor.