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Adjuvant radiotherapy delays recurrence following subtotal resection of spinal cord ependymomas
- Publication Year :
- 2012
- Publisher :
- Oxford University Press, 2012.
-
Abstract
- Background. Ependymoma is the most common glial tumor of the adult spinal cord. Current consensus recommends surgical resection with gross total resection (GTR) whenever possible. We performed a comprehensive review of the literature to evaluate whether adjuvant radiotherapy after subtotal resection (STR) has any benefit. Methods. A PubMed search was performed to identify adult patients with spinal cord ependymoma who underwent surgical resection. Only patients who had clearly defined extent of resection with or without adjuvant radiotherapy were included for analysis. Kaplan-Meier and multivariate Cox regression survival analyses were performed to determine the effects of adjuvant radiotherapy on progression-free survival (PFS) and overall survival (OS). Results. A total of 348 patients underwent surgical resection of spinal cord ependymomas, where GTR was obtained in 77.0% (268/348) of patients. Among those who received STR, 58.8% (47/80) received adjuvant radiotherapy. PFS was significantly prolonged among those who received adjuvant radiotherapy after STR (log rank; P , .001). This prolonged PFS with adjuvant radiotherapy remained significant in multivariate Cox regression analysis (STR versus STR + RT group; hazard ratio (HR) ¼ 2.26, P ¼ .047). By contrast, improved OS was only associated with GTR (GTR versus STR + RT group; HR ¼ 0.07, P ¼ .001) and benign ependymomas (HR ¼ 0.16, P ¼ .001). Conclusions. Surgery remains the mainstay treatment for spinal cord ependymomas, where GTR provides optimal outcomes with longest PFS and OS. Adjuvant radiotherapy prolongs PFS after STR significantly, and OS is improved by GTR and benign tumor grade only.
- Subjects :
- Ependymoma
Adult
Male
Cancer Research
medicine.medical_specialty
Adolescent
medicine.medical_treatment
Spinal Cord Neoplasm
Clinical Investigations
Neurosurgical Procedures
Benign tumor
Young Adult
medicine
Humans
Spinal Cord Neoplasms
Survival rate
Aged
business.industry
Spinal Cord Ependymoma
Hazard ratio
Middle Aged
medicine.disease
Prognosis
Combined Modality Therapy
Surgery
Radiation therapy
Log-rank test
Survival Rate
Oncology
Female
Radiotherapy, Adjuvant
Neurology (clinical)
Neoplasm Grading
Neoplasm Recurrence, Local
business
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....8cdc1cb58027256ebfb2769b6048293c