14th Asia Pacific Oncologists Annual Meeting
Sir Charles Gairdner Hospital, Australia
Title: A systematic review of intramedullary spinal cord ependymoma and astrocytoma
Biography: Kirsty Hamilton
The true impact of surgical resection and adjuvant therapies on survival in intramedullary ependymoma and astrocytoma is largely unknown. Searching of Medline, Embase and Clinicaltrials.gov databases were performed. Multivariate analyses were performed for overall survival (OS) and progression-free survival (PFS) data sets. This was achieved through a combination of Monte-Carlo methods and maximum likelihood estimation. 57 articles yielded results for 3022 patients. Gross-total resection (GTR) reduces mortality in both ependymoma and astrocytoma by a factor of 5.1. An interaction was identified between tumor grade and radiotherapy, such that for low-grade tumors, radiation treatment increased the risk of mortality 5.2 times, while for high-grade tumors radiotherapy decreased mortality by a factor of 1.9. High-grade tumors were associated with a 12 times risk of death over low-grade tumors. Adult patients were more likely to die from their disease compared with pediatric patients by a factor of 1.6. Regarding PFS, radiation treatment increased the rate of morbidity 1.9 times for both pathologies. Gender did not influence survival. 79% of patients demonstrated stable or improved functional neurological outcomes six months post-operatively. GTR improves OS in all tumor grades. Adjuvant radiation improves OS only in the presence of high-grade histology. Advancing age and high-grade histology are negative prognostic indicators. Gender does not influence survival.