Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
J Neurooncol. 2018 Dec;140(3):649-657. doi: 10.1007/s11060-018-2995-1. Epub 2018 Sep 10.
This study evaluated the outcomes of radiotherapy (RT) for spinal ependymoma with adverse features, such as incomplete resection or disseminated disease.
Twenty-five patients underwent RT for spinal cord ependymoma during 1991-2016. Twenty-four patients had gross disease on the pre-RT spinal magnetic resonance images. Six patients (24%) had disseminated disease. The World Health Organization grades were I (12 patients), II (12 patients), and III (1 patient). The RT fields were the tumor bed plus margin in 19 patients (76%), the entire craniospinal axis in 5 patients (20%), and the entire spinal canal with posterior cranial fossa in 1 patient (4%). The median RT dose was 50.4 Gy (range 44.0-59.4 Gy).
The median follow-up was 49 months (range 9-321 months), with 5-year overall and progression-free survival rates of 83.7% and 70.8%, respectively. Relative to patients with grade II/III ependymoma, patients with grade I ependymoma had higher 5-year rates of overall survival (100% vs. 69.4%, P = .088) and progression-free survival (100% vs. 42.3%, P = .02). Disease progression was observed in 4 patients who had grade II ependymoma, including 2 of 6 patients with disseminated disease and 2 of 19 patients with localized disease. Twelve patients (48%) exhibited improved neurological function. One patient who underwent craniospinal irradiation developed late hypopituitarism. No other RT-related late toxicities were observed.
Favorable survival outcomes were achieved using RT for spinal ependymoma with adverse prognostic features. Thus, RT may be an effective treatment option when complete tumor removal cannot be achieved.
本研究评估了放疗（RT）治疗具有不良特征的脊髓室管膜瘤的结果，例如不完全切除或播散性疾病。
1991 年至 2016 年间，25 例患者因脊髓室管膜瘤接受 RT。24 例患者在 RT 前脊髓磁共振成像上有大体疾病。6 例（24%）有播散性疾病。世界卫生组织分级为 I 级（12 例）、II 级（12 例）和 III 级（1 例）。RT 照射野为 19 例（76%）肿瘤床加边缘、5 例（20%）全颅脊柱轴和 1 例（4%）全椎管加后颅窝。中位 RT 剂量为 50.4 Gy（范围 44.0-59.4 Gy）。
中位随访时间为 49 个月（范围 9-321 个月），5 年总生存率和无进展生存率分别为 83.7%和 70.8%。与 II/III 级室管膜瘤患者相比，I 级室管膜瘤患者 5 年总生存率（100%比 69.4%，P=0.088）和无进展生存率（100%比 42.3%，P=0.02）更高。4 例 II 级室管膜瘤患者出现疾病进展，其中 6 例播散性疾病患者中有 2 例，19 例局限性疾病患者中有 2 例。12 例（48%）患者神经功能改善。1 例接受全颅脊柱照射的患者发生迟发性垂体功能减退症。未观察到其他与 RT 相关的迟发性毒性。
对于具有不良预后特征的脊髓室管膜瘤，使用 RT 治疗可获得良好的生存结果。因此，当无法完全切除肿瘤时，RT 可能是一种有效的治疗选择。
