Adjuvant radiotherapy delays recurrence following subtotal resection of spinal cord ependymomas
Adjuvant radiotherapy delays recurrence following subtotal resection of spinal cord ependymomas
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DOI：
10.1093/neuonc/nos286
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发表时间：
2013-02-01
期刊：
影响因子：
15.9
通讯作者：
Parsa, Andrew T.
中科院分区：
文献类型：
--
作者：
Oh, Michael C.;Ivan, Michael E.;Parsa, Andrew T.
背景室管膜瘤是成人脊髓最常见的神经胶质肿瘤。目前的共识建议手术切除与总切除（GTR），只要可能。我们对文献进行了全面的回顾，以评估次全切除术（STR）后辅助放疗是否有任何益处。进行PubMed检索，以确定接受手术切除的脊髓室管膜瘤成人患者。只有明确定义切除范围的患者（伴或不伴辅助放疗）才纳入分析。采用Kaplan-Meier和多因素考克斯回归生存分析方法分析放疗对无进展生存期（PFS）和总生存期（OS）的影响。共348例患者接受了脊髓室管膜瘤的手术切除，其中77.0%（268/348）的患者获得了GTR。在接受STR的患者中，58.8%（47/80）接受了辅助放疗。在STR后接受辅助放疗的患者中，PFS显著延长（对数秩; P < .001）。在多变量考克斯回归分析中，辅助放疗的PFS延长仍具有显著性（STR与STR + RT组;风险比（HR）= 2.26，P = 0.047）。相比之下，OS的改善仅与GTR（GTR与STR + RT组; HR = 0.07，P = .001）和良性室管膜瘤（HR = 0.16，P = .001）相关。结论。手术仍然是脊髓室管膜瘤的主要治疗方法，其中GTR提供了最佳结局，PFS和OS最长。辅助放疗可显著延长STR后的PFS，OS仅通过GTR和良性肿瘤分级改善。
Background. Ependymoma is the most common glial tumor of the adult spinal cord. Current consensus recommends surgical resection with gross total resection (GTR) whenever possible. We performed a comprehensive review of the literature to evaluate whether adjuvant radiotherapy after subtotal resection (STR) has any benefit.Methods. A PubMed search was performed to identify adult patients with spinal cord ependymoma who underwent surgical resection. Only patients who had clearly defined extent of resection with or without adjuvant radiotherapy were included for analysis. Kaplan-Meier and multivariate Cox regression survival analyses were performed to determine the effects of adjuvant radiotherapy on progression-free survival (PFS) and overall survival (OS).Results. A total of 348 patients underwent surgical resection of spinal cord ependymomas, where GTR was obtained in 77.0% (268/348) of patients. Among those who received STR, 58.8% (47/80) received adjuvant radiotherapy. PFS was significantly prolonged among those who received adjuvant radiotherapy after STR (log rank; P < .001). This prolonged PFS with adjuvant radiotherapy remained significant in multivariate Cox regression analysis (STR versus STR + RT group; hazard ratio (HR) = 2.26, P = .047). By contrast, improved OS was only associated with GTR (GTR versus STR + RT group; HR = 0.07, P = .001) and benign ependymomas (HR = 0.16, P = .001).Conclusions. Surgery remains the mainstay treatment for spinal cord ependymomas, where GTR provides optimal outcomes with longest PFS and OS. Adjuvant radiotherapy prolongs PFS after STR significantly, and OS is improved by GTR and benign tumor grade only.