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CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2017; 38(04): 420-426
DOI: 10.4103/ijmpo.ijmpo_202_15
Original Article

Prognostic Factors and Survival Outcomes of Intracranial Ependymoma Treated with Multimodality Approach

Kunhi Parambath Haresh
Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
,
Ajeet Kumar Gandhi
Department of Radiation Oncology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
,
Supriya Mallick
Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
,
Rony Benson
Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
,
Subhash Gupta
Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
,
Daya Nand Sharma
Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
,
Pramod Kumar Julka
Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
,
Goura Kisor Rath
Department of Radiation Oncology, Dr. B.R.A IRCH, All India Institute of Medical Sciences, New Delhi,, India
› Author Affiliations Financial support and sponsorship Nil.
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Abstract

Objectives: We aimed to analyze treatment outcomes of intracranial ependymoma (ICE) treated at our institute with multimodality approach. Materials and Methods: Demography, treatment details, and survival data of 40 patients (2005–2012) were collected in a predesigned pro forma. Kaplan Meier method was used to analyze disease-free survival (DFS) and the impact of prognostic factors was determined using univariate analysis (log-rank test). Multivariate analysis was performed using Cox-proportional hazard model. SPSS version 21.0 was used for all statistical analysis. Results: Male:female ratio was 29:11. Gross total resection: subtotal resection or less was 42.5%: 57.5%. A total of 16 patients (40%) had anaplastic histology. All except two patients received adjuvant radiotherapy. Four patients received concurrent chemotherapy (temozolomide [TMZ]) and 10 patients received adjuvant chemotherapy (6 carboplatin plus etoposide; 4 TMZ). Median follows up was 18 months (2–60 months). Median DFS for the entire cohort was 22.42 months. The estimated 1, 2, and 3 years DFS was found to be 58.5%, 41%, and 30.7%, respectively. On univariate analysis, patients receiving higher radiation dose (56 Gray vs. 60 Gray; hazard ratio [HR] 0.366; 95% confidence interval [CI] 0.142–0.9553; P = 0.02) and lower MIB labeling index (<20 vs. ≥20; HR 0.238; 95% CI 0.092–0.617; P = 0.001) had a better DFS. Higher radiation dose continued to be an independent prognostic factor on multivariate analysis (HR 0.212; 95% CI 0.064–0.856; P = 0.03). Conclusion: ICE has guarded prognosis. Adjuvant radiotherapy to a higher radiation dose improves survival. Higher MIB labeling index connotes a dismal survival despite the use of radiotherapy and chemotherapy.

Keywords

Chemotherapy - ependymoma - intracranial - radiation


Publication History

Article published online:
04 July 2021

© 2017. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used forcommercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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