Therapeutic effects of intracranial ependymoma in children

Abstract

Objective To investigate the treatment and prognosis of intracranial ependymoma in children. Methods The clinical data of 48 children with intracranial ependymoma who were first diagnosed and treated at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from September 2012 to September 2016 were retrospectively analyzed. The tumors were solitary in 48 patients, including under-tentorial tumors in 34 cases and supratentorial tumors in 14 cases. All patients underwent surgical resection, adjuvant radiotherapy and/or chemotherapy, and regular outpatient and telephone follow-up. Kaplan-Meier method was used to analyze the survival rate of patients, and Cox regression analysis was used to explore the influencing factors of survival. Results Of the 48 patients, 31 achieved gross total resection at the first operation and 17 received subtotal resection. Postoperative pathological results showed that classical ependymomas (WHO grade Ⅱ) was in 4 cases, anaplastic ependymomas (WHO grade Ⅲ) in 26 cases, and partial anaplastic ependymomas (between WHO grade Ⅱ and Ⅲ) in 18 cases. Postoperative local recurrence occurred in 21 cases, of which 20 cases underwent reoperation. 7 cases developed local recurrence with distant dissemination, of which 4 cases underwent reoperation. Of 48 patients, radiotherapy were performed in 46 cases/times and chemotherapy in 42 patients/times after operation. 2 cases died of hydrocephalus and 14 cases died of recurrence of tumors. The follow-up time of 48 patients ranged from 5 to 68 months, with a median of 34 months. The 3-year progression-free survival rate and overall survival rate were 29.3% and 70.8% respectively. The 3-year overall survival rate of 28 patients with recurrence was 62.1%. Univariate analysis showed that for children with ependymoma, the degree of first surgical excision was a factor affecting progression free survival(P=0.027). The age of diagnosis, the location of the tumors and the degree of last surgical excision might be the influencing factors of overall survival in patients with ependymoma (all P<0.05). Multivariate analysis showed that the degree of resection (RR=3.568, 95%CI: 1.638-7.775, P=0.001) was an independent factor affecting the survival time of patients. Conclusions Surgical resection is still the most important treatment for children with ependymoma. The degree of tumor resection is related to survival outcomes. Key words: Ependymoma; Child; Neurosurgical procedures; Chemotherapy, adjuvant; Radiotherapy, adjuvant; Prognosis