• Debra Nana Yeboa, Kia-Ping Liao, Beverly Ashleigh Guadagnolo, Ganesh Rao, Andrew Bishop, Caroline Chung, Jing Li, Claudio Esteves Tatsui, Laurence D Rhines, Sherise Ferguson, Arnold de la Cruz Paulino, and Amol Jitendra Ghia.
• Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA; Department of Health Services Research, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA. Electronic address: dnyeboa@mdanderson.org.
• World Neurosurg. 2019 Apr 1; 124: e580e594e580-e594.

BackgroundSpinal 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.MethodsOur study of 1345 patients with higher-grade spinal ependymoma used χ2 tests and simple and multivariable logistic regression models to assess demographic and clinical factors associated with therapy. Kaplan-Meier and log-rank tests were used to assess overall survival (OS).ResultsMost grade II patients received surgery alone (81.1%) compared with 36.8% of grade III. Approximately 60% of patients with grade III ependymomas received radiotherapy (RT) versus 15.3% of grade II (P < 0.001). Patients living ≤32 km (20 miles) from a facility were more likely to receive RT (P < 0.001) than were those living further away. On multivariable logistic regression, grade (grade III, odds ratio, 8.6; P < 0.001) and facility distance were significantly associated with receipt of RT (P < 0.0001). The 5-year and 10-year OS was 94.7%/85.1% for patients with grade II disease and 58.2%/46.4% for grade III disease (P < 0.0001). OS was highest at facilities treating an average of 15 patients over 10 years, corresponding to the top 81st percentile in volume. The 10-year OS was 92.6% at facilities treating at least 15 patients and 88.0% at facilities treating 6-14 patients.ConclusionsApproximately 40% of patients with 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.Copyright © 2019 Elsevier Inc. All rights reserved.

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