Long-Term Outcomes after Incomplete Resection of Intramedullary Grade II Ependymomas: Is Adjuvant Radiotherapy Justified?
Ependymomas are the most common intramedullary tumors in adults. While gross total resection is the aim of surgery, tumor infiltration might limit resection. In cases of subtotal removal, the necessary adjuvant management remains unclear. The aim of our study was to assess the need for adjuvant radi...
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MDPI AG
2023-07-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/15/14/3674 |
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| author | Elly Chaskis Mohamed Bouchaala Philippe David Fabrice Parker Nozar Aghakhani Steven Knafo |
| author_facet | Elly Chaskis Mohamed Bouchaala Philippe David Fabrice Parker Nozar Aghakhani Steven Knafo |
| author_sort | Elly Chaskis |
| collection | DOAJ |
| description | Ependymomas are the most common intramedullary tumors in adults. While gross total resection is the aim of surgery, tumor infiltration might limit resection. In cases of subtotal removal, the necessary adjuvant management remains unclear. The aim of our study was to assess the need for adjuvant radiotherapy after an incomplete resection of grade II intramedullary ependymomas (IME-II). We retrospectively reviewed all cases of IME-II operated upon at a single tertiary neurosurgical center from 2009 to 2018. Patients with anaplastic or myxopapillary ependymomas, and patients with a follow-up of less than three years, were excluded. We included 46 patients: 19 (41.3%) had a gross total resection; 21 (45.7%) had a subtotal resection; and 6 (13%) had a partial resection. None of the patients underwent adjuvant radiotherapy. Over a median follow-up of 79 months (range = 36–186), seven patients presented a radiological tumor progression with a mean delay of 50.9 months (range = 18–85), of which two were symptomatic (4.3%). Progression-free survival (PFS) was 90.1% at 5 years and 76.8% at 10 years. The extent of the resection was the only significant risk factor for secondary tumor progression (<i>p</i> = 0.012). Four of the seven patients with recurring IME-II were treated: three patients had a second surgery, leading to two GTR and one STR, followed by radiotherapy in one case, and one patient underwent radiotherapy alone. In this study, the rate of symptomatic progression and retreatment after incomplete resection of IME-II without adjuvant radiotherapy was low, suggesting a conservative approach in such cases. |
| first_indexed | 2024-03-11T01:12:18Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-11T01:12:18Z |
| publishDate | 2023-07-01 |
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| record_format | Article |
| series | Cancers |
| spelling | doaj.art-12da460b8bf94a8793969d9c40e749302023-11-18T18:42:31ZengMDPI AGCancers2072-66942023-07-011514367410.3390/cancers15143674Long-Term Outcomes after Incomplete Resection of Intramedullary Grade II Ependymomas: Is Adjuvant Radiotherapy Justified?Elly Chaskis0Mohamed Bouchaala1Philippe David2Fabrice Parker3Nozar Aghakhani4Steven Knafo5Department of Neurosurgery, Bicêtre Hospital, AP-HP, 94270 Le Kremlin-Bicêtre, FranceDepartment of Neurosurgery, Bicêtre Hospital, AP-HP, 94270 Le Kremlin-Bicêtre, FranceDepartment of Neurosurgery, Bicêtre Hospital, AP-HP, 94270 Le Kremlin-Bicêtre, FranceDepartment of Neurosurgery, Bicêtre Hospital, AP-HP, 94270 Le Kremlin-Bicêtre, FranceDepartment of Neurosurgery, Bicêtre Hospital, AP-HP, 94270 Le Kremlin-Bicêtre, FranceDepartment of Neurosurgery, Bicêtre Hospital, AP-HP, 94270 Le Kremlin-Bicêtre, FranceEpendymomas are the most common intramedullary tumors in adults. While gross total resection is the aim of surgery, tumor infiltration might limit resection. In cases of subtotal removal, the necessary adjuvant management remains unclear. The aim of our study was to assess the need for adjuvant radiotherapy after an incomplete resection of grade II intramedullary ependymomas (IME-II). We retrospectively reviewed all cases of IME-II operated upon at a single tertiary neurosurgical center from 2009 to 2018. Patients with anaplastic or myxopapillary ependymomas, and patients with a follow-up of less than three years, were excluded. We included 46 patients: 19 (41.3%) had a gross total resection; 21 (45.7%) had a subtotal resection; and 6 (13%) had a partial resection. None of the patients underwent adjuvant radiotherapy. Over a median follow-up of 79 months (range = 36–186), seven patients presented a radiological tumor progression with a mean delay of 50.9 months (range = 18–85), of which two were symptomatic (4.3%). Progression-free survival (PFS) was 90.1% at 5 years and 76.8% at 10 years. The extent of the resection was the only significant risk factor for secondary tumor progression (<i>p</i> = 0.012). Four of the seven patients with recurring IME-II were treated: three patients had a second surgery, leading to two GTR and one STR, followed by radiotherapy in one case, and one patient underwent radiotherapy alone. In this study, the rate of symptomatic progression and retreatment after incomplete resection of IME-II without adjuvant radiotherapy was low, suggesting a conservative approach in such cases.https://www.mdpi.com/2072-6694/15/14/3674spinal cordependymomasurgeryradiotherapy |
| spellingShingle | Elly Chaskis Mohamed Bouchaala Philippe David Fabrice Parker Nozar Aghakhani Steven Knafo Long-Term Outcomes after Incomplete Resection of Intramedullary Grade II Ependymomas: Is Adjuvant Radiotherapy Justified? Cancers spinal cord ependymoma surgery radiotherapy |
| title | Long-Term Outcomes after Incomplete Resection of Intramedullary Grade II Ependymomas: Is Adjuvant Radiotherapy Justified? |
| title_full | Long-Term Outcomes after Incomplete Resection of Intramedullary Grade II Ependymomas: Is Adjuvant Radiotherapy Justified? |
| title_fullStr | Long-Term Outcomes after Incomplete Resection of Intramedullary Grade II Ependymomas: Is Adjuvant Radiotherapy Justified? |
| title_full_unstemmed | Long-Term Outcomes after Incomplete Resection of Intramedullary Grade II Ependymomas: Is Adjuvant Radiotherapy Justified? |
| title_short | Long-Term Outcomes after Incomplete Resection of Intramedullary Grade II Ependymomas: Is Adjuvant Radiotherapy Justified? |
| title_sort | long term outcomes after incomplete resection of intramedullary grade ii ependymomas is adjuvant radiotherapy justified |
| topic | spinal cord ependymoma surgery radiotherapy |
| url | https://www.mdpi.com/2072-6694/15/14/3674 |
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