Prognostic factors for 31 cases of intracranial ependymomas after postoperative radiotherapy

Objective: To evaluate the prognostic factors and treatment results of intracranial ependymomas (EPs). Methods: Thirty-one intracranial EPs patients who received postoperative radiotherapy in Beijing Shijitan Hospital between January 2009 and June 2012 were analyzed retrospectively. Twenty-two males and 9 females had an average age of 18 years (range 3-60 years). Seventeen patients received gross total resection (GTR) while fourteen received subtotal resection (STR). Median total radiation dose was 53.9 Gy(48.6-60 Gy). The three-year and five-year progress-free survival (PFS) and overall survival (OS) were estimated with the Kaplan-Meier method. Univariate analysis was performed using eight clinical and dosimetric factors by Log-Rank testing. Cox proportional hazards model was used to identify the independent prognostic factors correlated to EPs. Results: The median time of follow-up was 51 months. At the endpoint of the follow-up period, 7 patients experienced tumor recurrence: 5 had a local recurrence (LR) and 2 had both LR and distant recurrence. Six patients died, 4 of which had cases of pediatric infratentorial anaplastic EPs. The three and five-year progress-free survival (PFS) were 80.6% and 75.9%. Overall survival (OS) at three-year and five-year were 83.9% and 76.2%, respectively. Univariate analysis showed a more favorable prognoses in terms of three-year PFS, five-year PFS and OS for GTR compared to STR (χ² = 4.685, 6.311, 4.238, P < 0.05). Besides, a more favourable univariate outcome in terms of five-year PFS was evident in patients when the total radiotherapy dose was > 55 Gy compared to ≤ 55 Gy (χ² = 4.210, P < 0.05), and no severe radiotherapy complications occurred. Conclusions: Surgery is the major treatment method, while adjuvant radiotherapy is important for subtotal resection and anaplastic EPs patients. Surgical resection and radiotherapy dose were relevant to prognosis. (authors)