Esen Caglayan, Bayatfard Pantea, Yazici Gozde, Aydin Guzide Burca, Soylemezoglu Figen, Babaoglu Berrin, Kutluk Tezer, Zorlu Faruk
Hacettepe University Faculty of Medicine, Department of Radiation Oncology, Ankara, Türkiye.
Turk Neurosurg. 2025;35(2):285-292. doi: 10.5137/1019-5149.JTN.46386-24.2.
To evaluate the oncological outcomes and the prognostic factors for children with ependymoma who receive radiotherapy (RT) ± chemotherapy after surgery.
The medical records of 71 children with ependymoma who received RT between 2001 and 2022 were retrospectively evaluated. Survival outcomes and prognostic factors were analyzed using log-rank and cox-regression tests. SPSS v24.0 was utilized for statistical analyses.
Gross total resection (GTR) was achieved in 37 (52%) patients. Craniospinal fluid (CSF) seeding was observed in 8 (11%) patients at the time of diagnosis. The median RT dose was 54 Gy (42-60 Gy). The median time from surgery to the first RT was 2.4 months (1-109 months). The median follow-up time was 65.9 months (2.5-242.8 months), and 5-y overall survival, progression-free survival (PFS), and local recurrence-free survival (LRFS) were 74%, 39%, and 46%, respectively. Recurrence was observed in 41 (58%) patients. Among patients who initiated treatment with chemotherapy, 5-y PFS and LRFS were higher in patients who received RT at the time of diagnosis than those who received RT at the progression (23% vs. 0%, p < 0.001 and 39% vs 0%, p < 0.001). In multivariate analysis, increased time from surgery to radiotherapy was found to be a poor prognostic factor for PFS.
Young age, less than GTR, large residual tumor volume, initiation of treatment with chemotherapy after surgery, and increased time from surgery to radiotherapy may deteriorate survival. RT should not be delayed until progression, even in young patients receiving chemotherapy.
评估接受手术联合放疗（RT）±化疗的室管膜瘤患儿的肿瘤学结局及预后因素。
回顾性分析2001年至2022年间接受放疗的71例室管膜瘤患儿的病历。采用对数秩检验和Cox回归检验分析生存结局和预后因素。使用SPSS v24.0进行统计分析。
37例（52%）患者实现了全切除（GTR）。8例（11%）患者在诊断时观察到脑脊液（CSF）播散。放疗的中位剂量为54 Gy（42 - 60 Gy）。从手术到首次放疗的中位时间为2.4个月（1 - 109个月）。中位随访时间为65.9个月（2.5 - 242.8个月），5年总生存率、无进展生存率（PFS）和局部无复发生存率（LRFS）分别为74%、39%和46%。41例（58%）患者出现复发。在开始化疗的患者中，诊断时接受放疗的患者5年PFS和LRFS高于疾病进展时接受放疗的患者（23%对0%，p < 0.001；39%对0%，p < 0.001）。多因素分析中，手术至放疗时间延长是PFS的不良预后因素。
年龄小、未达到GTR、残余肿瘤体积大、术后开始化疗以及手术至放疗时间延长可能会降低生存率。即使是接受化疗的年轻患者，放疗也不应延迟至疾病进展时。
