WHO Grade II and III supratentorial hemispheric ependymomas in adults: case series and review of treatment options
WHO Grade II and III supratentorial hemispheric ependymomas in adults: case series and review of treatment options
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DOI：
10.1007/s11060-008-9717-z
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发表时间：
2009-02-01
影响因子：
3.9
通讯作者：
Jensen, Randy L.
中科院分区：
文献类型：
--
作者：
Niazi, Toba N.;Jensen, Elizabeth M.;Jensen, Randy L.
幕上室管膜瘤及其间变性变异型是相对少见的中枢神经系统肿瘤，成人和儿童都会受到影响。虽然在儿科人群中的治疗算法已经很好地建立了，然而，在成人人群中的治疗较少被确定。本组3例成人幕上室管膜瘤患者中，2例为WHO III级(间变性)肿瘤，1例为WHO II级肿瘤，均获大体切除。对III级患者进行额外的放射治疗。病例1经24个月随访，未见肿瘤复发，且不需要辅助化疗。例2 6个月后肿瘤复发并伴有软脑膜胶质瘤病。增加以铂为基础的化疗并没有改善长期存活率；患者在14个月后死于这种疾病。病例3(WHO II级)不需要放射治疗。在42个月的随访中，肿瘤没有复发。在我们的经验中，所有半球上WHO II级或III级室管膜瘤的患者都实现了大体全切除，并对III级室管膜瘤进行了额外的放射治疗。所有患者都需要最初的近距离序列成像和随访。化疗的作用仍不确定，但对于可能患有更像儿科室管膜瘤的肿瘤的年轻患者来说，可能是必要的。
Supratentorial ependymomas and their anaplastic variants are relatively uncommon central nervous system neoplasms that afflict both adults and children. Whereas the treatment algorithm in the pediatric population is well established, however, treatment in the adult population is less defined. In our case series of three adult patients with supratentorial ependymomas, two patients had tumors of WHO Grade III (anaplastic variant) and one had tumor of WHO Grade II. In all patients, gross total resection was achieved. Additional radiation therapy was administered in the Grade III patients. Twenty-four-month follow-up in case 1 yielded no tumor recurrence and no requirement of adjuvant chemotherapy. In case 2, tumor recurred with leptomeningeal gliomatosis by 6 months. Addition of platinum-based chemotherapy did not improve long-term survival; the patient succumbed to the disease after 14 months. In case 3 (WHO Grade II), no radiation therapy was required. Tumor did not recur during the 42-month follow-up. In our experience, gross total resection was achieved in all patients with hemispheric supratentorial WHO Grade II or Grade III ependymomas with additional radiation therapy for Grade III variants. All patients require initial close serial imaging and follow-up. The role of chemotherapy is still uncertain but may be necessary in younger patients who may have tumors that behave more like the pediatric ependymomas.