Dissemination limits the survival of patients with anaplastic ependymoma after extensive surgical resection, meticulous follow up, and intensive treatment for recurrence

The extent of resection is the most consistent factor affecting outcome of intracranial ependymomas. The outcomes in patients with intracranial anaplastic ependymomas who underwent more than subtotal resection and intensive treatment for recurrence were reviewed retrospectively. Between 1989 and 2007, 18 patients underwent more than subtotal resection at Tohoku University Hospital. Adjuvant chemoradiation therapy was conducted in 16 patients. Meticulous follow-up was performed for early detection of recurrence. Intensive therapy including surgery and chemoradiation therapy was added for recurrence. Median survival in all 18 patients was 136 months. The 5- and 10-year survival rates were 59.1% and 50.7%, respectively. Eight patients died during the observation period, five of dissemination, but none of uncontrollable local recurrence. High resection rate, meticulous follow-up, and intensive treatment for recurrence improved the survival of patients with anaplastic ependymoma. Dissemination was the life-determining factor in this series of patients.