Die Rolle der Operation bei rezidivierenden Ependymomen bei Kindern

The role of surgery in recurrent ependymomas and its contribution to the outcome are not well defined yet. However, gross-total resection (GTR) has shown a strong benefit in newly diagnosed patients with an improvement in progression-free survival, its impact after recurrence is not known. Moreover, the role of the surgery in distant relapses or multiple local recurrences is similarly less well understood. The objective of this research was to estimate the effect of GTR after the recurrence on survival interval.

18 patients with ependymomas who underwent surgery for recurrent ependymomas between January 2008 and December 2023. Surgical treatment was stratified as GTR, subtotal resection (STR), or a biopsy. Kaplan-Meier analysis was performed for PFS and overall survival (OS), and the log-rank test was used to assess statistical significance. The Cox regression model was used for multivariable analysis.

18 children were involved in the study with a first ependymoma recurrence and follow-up data were collected. The median age was 5.76 years (95% CI 4.23–7.39 years) with a mean follow-up of 5.92 years. In 16 patients (83%), the original tumour was located in the infratentorial space. The 5-year PFS rates for the GTR and STR groups were 57.1% and 23.8%, respectively. The 5- and 10-year OS rates were 48.3% and 48% in the GTR group and 41% and 16.7% in the STR group, respectively. 11 patients presented with a second recurrence. The 5-year PFS and OS rates in patients who had GTR after a second recurrence were 33% and 50%, respectively.

GTR of local recurrent ependymomas can result in longer long-term survival in first and second recurrences. Further and larger studies and the comparison with other – higher case load centres are necessary to elucidate the role of surgery in distal recurrences.