Gross Total Resection of Childhood Intracranial Ependymoma is a Critically Important Factor in Survival

Abstract

OBJECTIVE This study aimed to evaluate the effect of prognostic factors and treatment on survival in childhood intracranial ependymoma. METHODS In the past two decades, 28 patients with pediatric intracranial ependymoma who received postoperative radiotherapy in our institute were evaluated statistically in terms of prognostic factors and sur-vival. Progression-free survival (PFS) and overall survival (OS) were analyzed using the Kaplan-Meier method. Possible prognostic factors, such as sex, histopathological grade, the extent of resection, tumor location, spinal metastasis, and chemotherapy were also analyzed by log-rank test. RESULTS Median age at diagnosis was 4 years (range, 1-17 years). Eighteen patients had infratentorial tumor, and 19 patients had Grade III tumor. Gross total resections (GTRs) were performed in 16 patients. The median clinical follow-up time was 66.9 months (range, 8-253 months). The estimated 5-year PFS and OS rates are 38% and 55%, respectively. The extent of resection was found the only prognostic factor associated with improved PFS and OS. Other factors, such as gender, histopathological grade, tumor location, spinal metastasis, and chemotherapy, showed no statistically significant effect on survival outcomes. CONCLUSION A multidisciplinary approach is required in the management of pediatric intracranial ependymomas. GTR is a crucial prognostic factor on survival. The lack of aggressive salvage treatments may result in worse survival. Future trials are needed to investigate molecular classification and individualized treatment algorithms.