Supratentorial ependymomas in adult patients

Citation
Th. Schwartz et al., Supratentorial ependymomas in adult patients, NEUROSURGER, 44(4), 1999, pp. 721-731
Citations number
60
Categorie Soggetti
Neurology,"Neurosciences & Behavoir
Journal title
NEUROSURGERY
ISSN journal
0148396X → ACNP
Volume
44
Issue
4
Year of publication
1999
Pages
721 - 731
Database
ISI
SICI code
0148-396X(199904)44:4<721:SEIAP>2.0.ZU;2-6
Abstract
OBJECTIVE: Ependymomas arise from different areas in the neuraxis and have variable outcomes that depend on tumor location and patient age at the time of presentation. The predictive value of histology for these tumors is unr esolved. We report a series of adult patients with supratentorial ependymom as to characterize the roles of surgery, histology, ploidy, and proliferati on index in tumor control. METHODS: Fourteen of the 23 supratentorial ependymomas were in the region o f the third ventricle and the remainder were located in the hemispheres. Re sections were gross total in 12 patients, subtotal in 8, and biopsy in 3. A single pathologist reviewed all slides and quantitated the deoxyribonuclei c acid. The mean follow-up duration was 95 months (+/-75 mo). RESULTS: All of the malignant ependymomas were hemispheric (n = 4). Mortali ty occurred only in patients with third ventricular tumors; two patients di ed as a result of surgical complications and three as a result of tumor pro gression. Kaplan-Meier estimates of 5- and 10-year survival rates were 100% for hemispheric and 72.5% for third ventricular tumors (62.5% including th e two perioperative deaths). The median time to recurrence was 53 months, w ith a 10-year progression-free survival rate of 27%. Univariate analysis re vealed that recurrence was associated with malignant histology, including m itoses, cellularity, and aneuploidy. For nonmalignant ependymomas, recurren ce was associated with subtotal resection and metastases. S-phase fraction did not correlate with recurrence. Only malignant histology correlated with recurrence on multivariate analysis. CONCLUSION: Although the numbers are too small to draw any definite conclus ions, treatment of ependymomas that arise in the supratentorial compartment in adult patients results in excellent outcomes despite frequent recurrenc es. Association with the third ventricle and metastases seem to have a nega tive impact on survival, whereas malignant histology, subtotal resection, a nd metastases may be predictors of recurrence.