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Infratentorial ependymomas: prognostic factors and outcome analysis in a multi-center retrospective series of 106 adult patients

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Abstract

Object

This study was undertaken to analyze outcomes and to assess the prognostic impact of age, location, surgery, radiotherapy (RT), and histopathology in a series of adult infratentorial ependymomas.

Methods

This was a retrospective study of a population of 106 adult patients with infratentorial ependymomas diagnosed between 1990 and 2004. A central pathological review of all cases was performed. Grading was according to the WHO and Marseille’s neograding classifications.

Results

The series consisted of 58 males (54.7%) and 48 females (45.3%) in the age range of 18-82 years. Using the WHO classification, 88 patients (83.0%) had grade II and 18 patients (17.0%) grade III ependymomas. Using the Marseille’s neograding system, 91 patients were low-grade and 15 high-grade. Gross total resection was achieved in 66 patients (62.3%). Thirty-seven patients (35.0%) received adjuvant RT. The 5- and 10-year overall survival rates for the entire cohort were 86.1% and 80.5%, respectively. On multivariate analysis, a preoperative Karnofski performance status score > 80, no recessus lateral extension and a low histological grade (Marseille’s grading) were associated with a longer overall survival. The 5- and 10-year progression-free survival rates for the entire cohort were 70.8% and 57.7%, respectively. On multivariate analysis, no recessus lateral extension, gross total resection and a low histological grade (Marseille’s grading) were associated with a longer progression-free survival. Adjuvant RT was significantly associated with a better overall and progression-free survival in incompletely resected WHO grade II ependymomas.

Conclusions

This study highlights the key role of histology in the clinical outcome and the fact that gross total resection is a main prognostic factor and the treatment of choice for posterior fossa ependymomas. The use of adjuvant RT in patients with incompletely resected WHO grade II ependymomas appears beneficial, but its effect on high-grade tumors remains to be determined.

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Abbreviations

CSF:

Cerebrospinal fluid

GTR (+):

Gross total resection

GTR (-):

Incomplete resection

KPS:

Karnofski performance status

Max:

Maximum

Min:

Minimum

MRI:

Magnetic resonance imaging

OS:

Overall survival

PFS:

Progression free-survival

RT:

Radiotherapy

WHO:

World Health Organization

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Acknowledgments

The authors wish to thank the French Neurosurgical Society of (SFNC) and the ANOCEF group (Association of French-speaking Neurologists and Neuro-oncologists) who supported this study with two grants awarded to P. Metellus and M. Barrie to collect data from the 24 French neurosurgical centers. We also thank Jacques Champier for reviewing the manuscript and all the neurosurgeons and pathologists who participated in this multi-institutional study. We also thank Dr Tom Barkas for linguistic help.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, “Pierre Wertheimer” GHE Neurological Hospital, Lyon, France

    Jacques Guyotat & Anne Durand

  2. Department of Neurosurgery, Timone Hospital, Marseille, France

    Philippe Metellus

  3. Department of Biostatistics, Timone Hospital, Marseille, France

    Roch Giorgi

  4. Neuro-oncological Unit, Timone Hospital, Marseille, France

    Marylin Barrie & Olivier Chinot

  5. Department of Pathology and Neuropathology, “Pierre Wertheimer” GHE Neurological Hospital, Lyon, France

    Anne Jouvet

  6. Department of Pathology and Neuropathology, Timone Hospital, Marseille, France

    Dominique Figarella-Branger

  7. INSERM U482, Faculté RTH Laennec, rue G. Paradin, Lyon, France

    Michelle Fevre-Montange

  8. Service de neurochirurgie D Hopital neurologique Pierre Wertheimer GHE, 59 boulevard Pinel, 69394, Lyon, Cedex 3, France

    Jacques Guyotat

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  1. Jacques Guyotat
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  2. Philippe Metellus
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  7. Olivier Chinot
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  8. Anne Durand
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  9. Dominique Figarella-Branger
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Corresponding author

Correspondence to Jacques Guyotat.

Additional information

Supported by the Club de Neuro-Oncologie de la Société Française de Neurochirurgie (SFNC) and the Association des Neuro-Oncologues d’Expression Française (ANOCEF)

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Guyotat, J., Metellus, P., Giorgi, R. et al. Infratentorial ependymomas: prognostic factors and outcome analysis in a multi-center retrospective series of 106 adult patients. Acta Neurochir 151, 947–960 (2009). https://doi.org/10.1007/s00701-009-0417-z

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  • DOI: https://doi.org/10.1007/s00701-009-0417-z

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