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Neurosurgery. 2014 Sep;75(3):205-14; discussion 213-4. doi: 10.1227/NEU.0000000000000408.

Outcomes after surgery and radiotherapy for spinal myxopapillary ependymoma: update of the MD Anderson Cancer Center experience.

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Departments of ‡Radiation Oncology and ¶Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas; §Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey; ‖School of Nursing, The University of Texas Health Science Center at Houston, Houston, Texas; #Department of Radiation Oncology, University of Southern California, Los Angeles, California.



The role of radiotherapy after surgery for myxopapillary ependymoma (MPE) is unclear.


To review long-term outcomes after surgery, with or without radiation, for spinal MPE.


Fifty-one patients with spinal MPE treated from 1968 to 2007 were included. Associations between clinical variables and overall survival (OS), progression-free survival (PFS), and local control (LC) were tested with Cox regression analysis.


The median age at diagnosis was 35 years (range, 8-63 years). Twenty patients (39%) had surgery alone, 30 (59%) had surgery plus radiotherapy (RT), and 1 (2%) had RT only. At a median follow-up of 11 years (range, 0.2-37 years), 10-year OS, PFS, and LC for the entire group were 93%, 63%, and 67%, respectively. Nineteen patients (37%) had disease recurrence, and the recurrence was mostly local (79%). Twenty-eight of 50 patients who had surgery (56%) had gross total resection; 10-year LC was 56% after surgery vs 92% after surgery and RT (log-rank P = .14); the median time of LC was 10.5 years for patients receiving gross total resection plus RT, and 4.75 years for gross total resection only (P = .03). Among 16 patients with subtotal resection and follow-up data, 10-year LC was 0% after surgery vs 65% for surgery plus RT (log-rank P = .008). On multivariate analyses adjusting for resection type, age older that 35 years at diagnosis and receipt of adjuvant radiation were associated with improved PFS (hazard ratio [HR]: 0.14, P = .003 and HR: 0.45, P = .009) and LC (HR: 0.22, P = .02 and HR: 0.45, P = .009).


Postoperative radiotherapy after resection of MPE was associated with improved PFS and LC.

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