1Department of Radiation Oncology, Asan Medical Center,College of Medicine, University of Ulsan, Seoul, Korea.sdahn@amc. seoul.kr 2Department of Neurological Surgery, Asan Medical Center,College of Medicine, University of Ulsan, Seoul, Korea.
Published online: December 31, 2002.
ABSTRACT
PURPOSE: We evaluated the patterns of failure, survival rate, prognostic factors and treatment related complication in postoperative radiation treatment of patients with ependymoma.
MATERIALS AND METHODS: We retrospectively analyzed 25 patients with histologically confirmed ependymoma treated between Jun. 1990 and Jun. 2001 with postoperative radiotherapy at Asan Medical Center. The study group comprised of 16 men and 9 women, with a median age of 23 years; including 6 supratentorial, 15 infratentorial and 4 spinal cord lesions. The extents of resection were ranked as either: gross total, near total, subtotal, partial resection or biopsy, with these types of surgical resection being performed in 13, 3, 6, 1 and 2 patients, respectively.
Twelve of the patients had low grade ependymoma, and the other 13 a high grade tumor. The postoperative irradiation was administered using 4 MV or 6 MV photons, up to median dose of 55.0 Gy (range, 45.0~59.4 Gy), with the radiation field encompassing the preoperative tumor volume plus a 2 cm margin. Only 8 of the patients received either pre- or postoperative chemotherapy. The median follow-up period of survivors was 43 months.
RESULTS: Ten of the 25 patients (40%) developed a recurrence, and 5 died. Of the 10 recurred patients, 6 showed an in-field recurrence, and one developed both an in-field and an out of field recurrence. The remaining 3 patients showed an out of field recurrence, including one case with a leptomeningeal recurrence. The 5-year overall survival, and progression-free, survival rates were 74.0 and 56.1%, respectively. The histological grades were statistically significant prognostic factors of the overall and progression-free survival rates. There were no significant treatment related complications, with the exception of one case of panhypopituitarism, which occurred 30 months after completion of the radiotherapy.
CONCLUSION: The main pattern of recurrence was due to local failure. In order to improve the local control, and to reduce complications, advanced radiation treatment techniques, such as 3 dimensional radiotherapy, may be needed.
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