National Patterns of Care in the Management of World Health Organization Grade II and III Spinal Ependymomas
| Autor: | Debra Nana Yeboa, Amol J. Ghia, Jing Li, Sherise Desiree Ferguson, Beverly Ashleigh Guadagnolo, Ganesh Rao, Andrew J. Bishop, Caroline Chung, Laurence D. Rhines, Kia ping Liao, C. Tatsui, Arnold C. Paulino |
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| Rok vydání: | 2018 |
| Předmět: |
Ependymoma
Patterns of care medicine.medical_specialty business.industry medicine.medical_treatment Incidence (epidemiology) Disease medicine.disease Logistic regression World health Radiation therapy 03 medical and health sciences 0302 clinical medicine 030220 oncology & carcinogenesis Internal medicine Adjuvant therapy Medicine Surgery Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | World neurosurgery. |
| ISSN: | 1878-8769 |
| Popis: | Spinal 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.Our study of 1345 patients with higher-grade spinal ependymoma used χMost 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 (P0.001). Patients living ≤32 km (20 miles) from a facility were more likely to receive RT (P0.001) than were those living further away. On multivariable logistic regression, grade (grade III, odds ratio, 8.6; P0.001) 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 (P0.0001). 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.Approximately 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. |
| Databáze: | OpenAIRE |
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