Ependimomas intracraneales pediátricos: Si el objetivo es la curación, ¿cuál es el verdadero costo?

Abstract

Introduction: To better characterize the neurological morbidity after maximal resection surgery followed by radiotherapy in children with infratentorial ependymoma, we decided to study the preoperative neurological status and compare it with short and long-term postoperative evaluations. At the same time, we conducted a tumor progression-free survival (PFS) study to find out which factors have the greatest impact on the prognosis of this type of injury.
Methods: A retrospective cohort study was carried out in which all pediatric patients with a diagnosis of infratentorial ependymoma were included. The different risk factors were identified and it was observed how they evolved over time. Patients were followed for a minimum of 24 months for survival analysis.
Results: 26 pediatric patients with posterior fossa ependymomas were analyzed between 2008-2019. We found a statistically significant difference between the presurgical FSS (Functional Status Scale) and the immediate postoperative FSS (p = 0.03), however this difference is lost when we compare the presurgical with the FSS after one year (p = 0.07).
Total excision of the lesion has a protective effect on tumor PFS (p = 0.02), while having required more than 3 surgeries negatively affects tumor PFS (p = 0.04), as does the lateralized location of the tumor (p = 0.04).
Conclusion: Complete excision of posterior fossa ependymomas continues to be the most important prognostic factor for tumor progression-free survival. The immediate neurological deterioration produced by the surgical procedure would appear to improve on the long-term evaluation.