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Abstract
Background and purpose: To evaluate the impact of adjuvant postoperative radiotherapy (PORT) in adult WHO grade II-III intracranial ependymoma (IEPN).

Materials and methods: A total of 172 pathologically confirmed adult grade II-III IEPN patients from 12 institutions were eligible. Of them, 106 (61.6%) and 66 (38.4%) patients were grade II and III, respectively. For grade II and III IEPNs, 51 (48.1%) and 59 (89.4%) patients received PORT, respectively. The median dose to the primary tumor bed was 54.0 Gy and 59.4 Gy for grade II and III patients, respectively. The prognostic impact of sex, age, performance, WHO grade, location, size, surgical extent, and PORT on local control (LC), progression-free survival (PFS), and overall survival (OS) were evaluated by univariate and multivariate analysis.

Results: The median follow-up period for survivors was 88.1 months. The 5-/10-year LC, PFS, and OS rates were 64.8%/54.0%, 56.4%/44.8%, and 76.6%/71.0%, respectively. On multivariate analysis, adjuvant PORT significantly improved LC (P = 0.002), PFS (P = 0.002), and OS (P = 0.043). Older age (P < 0.001), WHO grade III (P < 0.001), larger tumor size (P = 0.004), and lesser surgical extent (P < 0.001) were also negative factors for OS. Adjuvant PORT also improved LC (P = 0.010), PFS (P = 0.007), and OS (P = 0.069) on multivariate analysis for grade II IEPNs.

Conclusion: This multicenter retrospective study supports the role of adjuvant PORT in terms of disease control and survival in adult grade II-III IEPNs. Prospective randomized trials focused on individualized treatment based on molecular subtypes is warranted.

Figure 1. Adjusted survival curves using the Cox proportional hazard model for (A) local control, (B) progression-free survival, and (C) overall survival based on the use of postoperative radiotherapy in WHO grade II–III patients.

Figure 2. Adjusted survival curves using the Cox proportional hazard model for (A) local control, (B) progression-free survival, and (C) overall survival based on the use of postoperative radiotherapy in WHO grade II patients.

Affiliations

Chan Woo Wee  1 , Il Han Kim  2 , Chul-Kee Park  3 , Do Hoon Lim  4 , Do-Hyun Nam  5 , Hong In Yoon  6 , Chang-Ok Suh  6 , Jong Hee Chang  7 , Woong-Ki Chung  8 , Tae-Young Jung  9 , Shin-Hyung Park  10 , Chae-Yong Kim  11 , Young Zoon Kim  12 , Ho Shin Gwak  13 , Kwan Ho Cho  14 , Jin Hee Kim  15 , Jung Ho Im  16 , Woo Chul Kim  17 , Sung-Hwan Kim  18 , In Ah Kim  19
1 Department of Radiation Oncology, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea.
2 Department of Radiation Oncology, Seoul National University Hospital, Republic of Korea.
3 Department of Neurosurgery, Seoul National University Hospital, Republic of Korea.
4 Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
5 Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
6 Department of Radiation Oncology, Yonsei Cancer Center, Seoul, Republic of Korea.
7 Department of Neurosurgery, Yonsei Cancer Center, Seoul, Republic of Korea.
8 Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea.
9 Department of Neurosurgery, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea.
10 Department of Radiation Oncology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
11 Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
12 Division of Neuro-Oncology and Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
13 Department of Neurosurgery, National Cancer Center, Goyang, Republic of Korea.
14 Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea.
15 Department of Radiation Oncology, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea.
16 Department of Radiation Oncology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea.
17 Department of Radiation Oncology, Inha University Hospital, Incheon, Republic of Korea.
18 Department of Radiation Oncology, St. Vincent's Hospital, Suwon, Republic of Korea.
19 Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. Electronic address: inah228@snu.ac.kr.