Radiotherapy for partially resected spinal ependymomas: a retrospective study of 60 cases

Ependymomas (Es) and myxopapillary ependymomas (mpEs) are the most common primary tumours of the spinal cord. Recurrence-free survival depends on local control of the tumour. The value of additional radiotherapy (RT) is still a matter of debate. The aim of this retrospective study was to analyse radiotherapy, surgery and the preoperative state with regard to recurrence rate and long-term neurological outcome. Sixty patients with spinal Es (40) and spinal mpEs (20) were included. According to local policy, 14 patients who underwent total resection and 20 patients with incomplete resection were irradiated postoperatively. Total resection was achieved in 34 of the 60 tumours. Preoperative state and long-term outcome was assessed according to a previously published scale. When postoperative RT was applied after partial resection, only 3 of 11 Es and 1 of 9 mpEs recurred. All partially resected non-radiated Es (n=3) and 2 of the 3 partially resected non-radiated mpEs recurred. There was no recurrence after total resection. Only one of 6 patients with disseminated mpEs had clinical symptoms caused by the disseminated tumour. Long-term neurological outcome was related to preoperative conditions with no difference between partially and totally resected tumours. Our study shows that RT is only beneficial for partially resected Es and mpEs. Local recurrence-free survival of spinal Es and mpEs is obtained by total resection. Long-term neurological outcome is related to preoperative conditions. Seeding is seen in mpEs and does not cause clinical symptoms in most of the patients.