|
1
|
Wang C, Rooney MK, Alvarez-Breckenridge C, Beckham TH, Chung C, De BS, Ghia AJ, Grosshans D, Majd NK, McAleer MF, McGovern SL, North RY, Paulino AC, Perni S, Reddy JP, Rhines LD, Swanson TA, Tatsui CE, Tom MC, Yeboa DN, Li J. Outcomes and Pattern of Care for Spinal Myxopapillary Ependymoma in the Modern Era-A Population-Based Observational Study. Cancers (Basel) 2024; 16:2013. [PMID: 38893133 PMCID: PMC11171081 DOI: 10.3390/cancers16112013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/18/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
(1) Background: Myxopapillary ependymoma (MPE) is a rare tumor of the spine, typically slow-growing and low-grade. Optimal management strategies remain unclear due to limited evidence given the low incidence of the disease. (2) Methods: We analyzed data from 1197 patients with spinal MPE from the Surveillance, Epidemiology, and End Results (SEER) database (2000-2020). Patient demographics, treatment modalities, and survival outcomes were examined using statistical analyses. (3) Results: Most patients were White (89.9%) with a median age at diagnosis of 42 years. Surgical resection was performed in 95% of cases. The estimated 10-year overall survival was 91.4%. Younger age (hazard ratio (HR) = 1.09, p < 0.001) and receipt of surgery (HR = 0.43, p = 0.007) were associated with improved survival. Surprisingly, male sex was associated with worse survival (HR = 1.86, p = 0.008) and a younger age at diagnosis compared to females. (4) Conclusions: This study, the largest of its kind, underscores the importance of surgical resection in managing spinal MPE. The unexpected association between male sex and worse survival warrants further investigation into potential sex-specific pathophysiological factors influencing prognosis. Despite limitations, our findings contribute valuable insights for guiding clinical management strategies for spinal MPE.
Collapse
Affiliation(s)
- Chenyang Wang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Michael K. Rooney
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | | | - Thomas H. Beckham
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Brian S. De
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Amol J. Ghia
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - David Grosshans
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Nazanin K. Majd
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Mary F. McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Susan L. McGovern
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Robert Y. North
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (L.D.R.)
| | - Arnold C. Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Subha Perni
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Jay P. Reddy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Laurence D. Rhines
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (L.D.R.)
| | - Todd A. Swanson
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Claudio E. Tatsui
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (L.D.R.)
| | - Martin C. Tom
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Debra N. Yeboa
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| | - Jing Li
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.K.R.); (D.G.); (A.C.P.); (M.C.T.); (J.L.)
| |
Collapse
|
|
2
|
Balodis A, Ņeverčika V, Zavertjajeva M, Mikijanskis R, Kalnina M, Breikša-Vaivode A, Briede I. Giant Myxopapillary Ependymoma with Multi-Site Neural Axis Metastases: A Rare Case with Suboptimal Outcome. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e942392. [PMID: 38291726 PMCID: PMC10846752 DOI: 10.12659/ajcr.942392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/22/2023] [Accepted: 11/28/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Myxopapillary ependymoma is a rare type of slow-growing tumor that mainly occurs in the spinal cord, particularly in the region of the conus medullaris and the cauda equina. It originates from the ependymal glial cells found in the filum terminale. CASE REPORT We present a clinical case of a 44-year-old male patient who presented with symptoms of non-specific pain in the lower back persisting for the past 2 years. He did not report any specific neurological deficits or radicular symptoms. Unenhanced MRI of the lumbar spine showed a giant intradural, extramedullary, heterogenous, expansive tumor at the level L1-S4 with erosion of the sacral bone and invasion of presacral tissue. Based on its characteristic localization and growth pattern, suspicion arose for myxopapillary ependymoma. Biopsy confirmed the initial diagnosis. Partial resection of the tumor with laminectomy and laminoplasty was deemed necessary. Preoperative neural axis MRI showed contrast-enhancing lesions in the cerebellum and the cervical and thoracic spine; therefore, adjuvant radiation therapy was administered. Following the surgery, the patient experienced intermittent episodes of neurological deficits and required physiotherapy. Control MRI a year after the operation showed tumor growth and more metastases along the neural axis. CONCLUSIONS Complete surgical excision of the tumor is the preferred treatment approach, but there is a risk of recurrence even after total excision, so radiotherapy is recommended to minimize the risk of recurrence. Prior to surgery, it is essential to conduct MRI/PET/CT of the head and spine to assess the possibility of metastases.
Collapse
Affiliation(s)
- Arturs Balodis
- Institute of Diagnostic Radiology, Pauls Stradiņš Clinical University Hospital, Riga, Latvia
- Department of Radiology, Riga Stradiņš University, Riga, Latvia
| | | | - Marija Zavertjajeva
- Institute of Diagnostic Radiology, Pauls Stradiņš Clinical University Hospital, Riga, Latvia
- Department of Radiology, University of Latvia, Riga, Latvia
| | - Raimonds Mikijanskis
- Department of Neurosurgery, Pauls Stradiņš Clinical University Hospital, Riga, Latvia
| | | | | | - Inese Briede
- Department of Pathology, Riga Stradiņš University Hospital, Riga, Latvia
| |
Collapse
|
|
3
|
Multifocal lumbar myxopapillary ependymoma presenting with drop metastasis: a case report and review of the literature. Spinal Cord Ser Cases 2022; 8:43. [PMID: 35459220 PMCID: PMC9033832 DOI: 10.1038/s41394-022-00513-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/03/2022] [Accepted: 04/13/2022] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Spinal myxopapillary ependymomas (SME) are rare WHO grade II neoplasms of the spinal cord. Despite their good prognosis, they have a high propensity for metastasis and recurrence, although the presentation of SME as multifocal is uncommon. CASE PRESENTATION Here we describe a rare case of a 34-year-old man who presented with painful bilateral radiculopathy with sexual dysfunction and altered sensation with defecation. The patient also reported worsening weakness of bilateral lower extremities when climbing stairs. Biopsy results revealed multifocal SME in the lumbar and sacral spine that was treated with staged surgical resection and post-operative focal radiation therapy. DISCUSSION We discuss and evaluate surgical resection and the role of postoperative radiotherapy for SME. We also review the literature surrounding multifocal SME presenting in adults.
Collapse
|