Ependymoma in children: surgical treatment, technological advances and outcomes over a 55-year period in North West England

Ependymoma in children: surgical treatment, technological advances and outcomes over a 55-year period in North West EnglandObjective: Surgical resection has always been the mainstay management for childhood ependymoma, with the use of adjuvant therapies advocated according to patient age. We aimed to evaluate the influence of new technologies and the re-organisation of paediatric neurosurgical services on survival outcomes.Study design: The patient list and tumour type was obtained from the North West Tumour Registry between January 1954 and December 2008. The patient’s case notes were retrospectively analysed. Subgroup univariate and multivariate analysis was performed for time period, extent of resection, location and age. Survival between subgroups was tested for significance using the log-rank test. Demographics: 129 patients were obtained from the registry with a histological diagnosis of ependymoma. The age ranged from 3.5 months to 182.5 months (15 years) with a mean age at presentation of 5.5years. The male to female ratio was 0.9:1.Results:Patients were stratified into five 11-year time periods from 1954 – 2008 according to their date of diagnosis. 5-year overall survival improved significantly from 20% to 71% for children diagnosed between 1954-1964 and 1998-2008 respectively. 5-year progression free survival also improved significantly, this was most pronounced for the latter time periods. This trend was also mirrored by the gross total resection rate which for the latter time periods increased substantially from 20% to 57%.Conclusion:We advocate that the introduction of new surgical technologies and amalgamation on paediatric neurosurgical services in North West England has led to improvements in ependymoma gross total resection rates and PFS.