Jung Jinhong, Choi Wonsik, Ahn Seung Do, Park Jin Hong, Kim Su Ssan, Kim Young Seok, Yoon Sang Min, Song Si Yeol, Lee Sang-Wook, Kim Jong Hoon, Choi Eun Kyung
Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Radiat Oncol J. 2012 Dec;30(4):158-64. doi: 10.3857/roj.2012.30.4.158. Epub 2012 Dec 31.
To evaluated the patterns of failure, survival rate, treatment-related toxicity and prognostic factors in postoperative radiotherapy of patients with ependymoma.
Thirty patients who underwent surgery and postoperative radiotherapy for ependymoma between the period of June 1994 and June 2008 were reviewed retrospectively. The age of patients ranged from 21 months to 66 years (median, 19 years). Seventeen patients had grade II ependymoma, and 13 had grade III anaplastic ependymoma according to the World Health Organization grading system. The postoperative irradiation was performed with 4 or 6 MV photon beam with median dose of 52.8 Gy (range, 45 to 63 Gy), and radiation field including 2 cm beyond the preoperative tumor volume. Median follow-up period was 51 months (range, 12 to 172 months).
Fourteen out of 30 (46.7%) patients experienced recurrence, and 12 of those died. Among those 14 patients who experienced recurrence, 11 were in-field and 3 were out-of-field recurrence. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 66.7% and 56.1%, respectively. On univariate analysis, tumor grade was a statistically significant prognostic factor for OS and PFS. There were two complications after surgery and postoperative radiotherapy, including short stature and facial palsy on the left side.
We observed good survival rates, and histologic grade was a prognostic factor affecting the OS and PFS. Almost all recurrence occurred in primary tumor site, thus we suggest further evaluation on intensity-modulated radiotherapy or stereotatic radiosurgery for high-risk patients such as who have anaplastic ependymoma.
评估室管膜瘤患者术后放疗的失败模式、生存率、治疗相关毒性及预后因素。
回顾性分析1994年6月至2008年6月期间30例行室管膜瘤手术及术后放疗的患者。患者年龄从21个月至66岁（中位年龄19岁）。根据世界卫生组织分级系统，17例为Ⅱ级室管膜瘤，13例为Ⅲ级间变性室管膜瘤。术后放疗采用4或6MV光子束，中位剂量52.8Gy（范围45至63Gy），放疗野包括术前肿瘤体积外放2cm。中位随访期为51个月（范围12至172个月）。
30例患者中有14例（46.7%）复发，其中12例死亡。在14例复发患者中，11例为野内复发，3例为野外复发。5年总生存率（OS）和无进展生存率（PFS）分别为66.7%和56.1%。单因素分析显示，肿瘤分级是OS和PFS的统计学显著预后因素。手术及术后放疗后有2例并发症，包括身材矮小和左侧面神经麻痹。
我们观察到良好的生存率，组织学分级是影响OS和PFS的预后因素。几乎所有复发都发生在原发肿瘤部位，因此我们建议对间变性室管膜瘤等高风险患者进一步评估调强放疗或立体定向放射外科治疗。
