Cancer Res Treat. 2002 Dec;34(6):450-6. doi: 10.4143/crt.2002.34.6.450.
We evaluated the patterns of failure, survival rate, prognostic factors and treatment related complication in postoperative radiation treatment of patients with ependymoma.
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.
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.
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.
我们评估了术后放疗治疗室管膜瘤患者的失败模式、生存率、预后因素和治疗相关并发症。
我们回顾性分析了 1990 年 6 月至 2001 年 6 月期间在亚洲医学中心接受术后放疗的 25 例组织学证实的室管膜瘤患者。研究组包括 16 名男性和 9 名女性，中位年龄为 23 岁；包括 6 例幕上、15 例幕下和 4 例脊髓病变。切除程度分为全切除、近全切除、次全切除、部分切除或活检，分别有 13、3、6、1 和 2 例患者接受上述类型的手术切除。12 例患者为低级别室管膜瘤，其余 13 例为高级别肿瘤。术后放疗采用 4MV 或 6MV 光子，中位剂量为 55.0Gy（范围 45.0~59.4Gy），照射野包括术前肿瘤体积加 2cm 边界。只有 8 例患者接受了术前或术后化疗。幸存者的中位随访期为 43 个月。
25 例患者中有 10 例（40%）出现复发，5 例死亡。在 10 例复发患者中，6 例为肿瘤内复发，1 例为肿瘤内和肿瘤外复发。其余 3 例为肿瘤外复发，包括 1 例脑膜复发。5 年总生存率和无进展生存率分别为 74.0%和 56.1%。组织学分级是总生存率和无进展生存率的统计学显著预后因素。除 1 例放疗后 30 个月发生全垂体功能减退症外，无明显治疗相关并发症。
复发的主要模式是局部失败。为了提高局部控制率，减少并发症，可能需要使用先进的放疗技术，如三维放疗。
