National Patterns of Care in the Management of WHO Grade II and III Spinal Ependymomas.

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National Patterns of Care in the Management of WHO Grade II and III Spinal Ependymomas.

World Neurosurg. 2019 Jan 11;:

Authors: Yeboa DN, Liao KP, Guadagnolo BA, Rao G, Bishop A, Chung C, Li J, Tatsui CE, Rhines LD, Ferguson S, Paulino AC, Ghia AJ

Abstract
BACKGROUND: Spinal ependymomas are rare with an incidence of 1 per 100,000. Given the paucity of data for higher grade II and III disease, the management and patterns of care require further investigation.
METHODS: Our study of 1,345 patients with higher grade spinal ependymoma utilized chi-square tests, simple and multivariable logistic regression models to assess demographic and clinical factors associated with therapy. Kaplan Meier and log-rank test were used to assess overall survival (OS).
RESULTS: The majority of grade II patients received surgery alone (81.1%) in comparison to 36.8% of grade III. Approximately 60% percent of grade III ependymomas received radiotherapy(RT) versus 15.3% of grade II (P< 0.001). Patients ≤20 miles from a facility were more likely to receive RT (P<0.001) than those living further away. On multivariable logistic regression, grade (grade III: OR 8.6, P<0.001) and facility distance were significantly associated with receipt of RT (P<0.0001). The 5 and 10-year OS rates were 94.7%/ 85.1% for patients with grade II disease and 58.2%/46.4% for grade III disease (P<0.0001). OS rates were highest at facilities treating an average of 15 patients over 10 years, corresponding to the top 81st percentile in volume. The 10-year OS rates were 92.6% at facilities treating at least 15 patients and 88.0% at facilities treating 6-14 patients.
CONCLUSIONS: Approximately 40% of grade III ependymomas do not receive immediate adjuvant therapy which may be related to distance from a facility. Patients with this rare tumor may benefit from multidisciplinary care at facilities with a larger volume.

PMID: 30641236 [PubMed - as supplied by publisher]

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