Prognostic factors and management of intracranial ependymomas

Between the years 1960 and 1983, 26 patients with the diagnosis of ependymoma were treated at our institution. Twenty-one patients received postoperative radiotherapy, of whom six patients had supratentorial tumors and 15 had infratentorial tumors. The median dose to the brain was 53.75 Gy with a range of 30-60 Gy. The median dose to the spine was 37.5 Gy with a range of 10-46 Gy. The median survival time for all 26 patients is two years. The median survival time for patients less than 10 years old is two years as compared to six years for patients older than 15 years at the time of diagnosis (0.05 less than p less than 0.10). Patients had a median survival time of greater than five years if the primary tumor was completely resected as compared to two years in the incompletely resected or biopsy only group (p less than 0.25). The median survival time MST for the low grade tumors is 9 years as compared to one year for the high grade tumors (p less than 0.01). The five-year survival was 38% in patients with infratentorial tumors who received craniospinal irradiation as compared to 33% with whole brain and 0% with partial brain radiation including the spine. All five patients with high grade infratentorial tumors subsequently failed in the cerebrospinal axis despite cranio-spinal irradiation in two and partial brain plus whole spine in another two of the patients. In conclusion, the favorable prognostic factors (in order of increasing importance) for patients with intracranial ependymomas are: age greater than 15 (marginal), complete resection and low histological grade.