Management And Treatment Of Pediatric Spinal Cord Ependymoma: Results From An International Multi-Institutional Review

Spinal cord ependymoma (SCE) is rare in the pediatric population. The management of this tumor is heterogeneous between treatment centers. We reviewed a multi-institution, international cohort of SCE and evaluated clinical, pathologic, and treatment factors and their impact on therapeutic outcomes. Patients age <21 years with SCE treated between 1967-2018 were retrospectively reviewed at five institutions. Cases with available tissue underwent central pathology review at a reference institution. Nonparametric descriptive statistics, Kaplan-Meier estimator, and recursive partitioning analysis were used for analysis. One hundred and twenty-five eligible patients were identified. Median follow-up was 86 months. The most common location was the lower thoracic and lumbar spine. Eighteen patients (14.4%) presented with metastatic disease. Fifty-five percent of patients had myxopapillary histology (grade I), 17.7% were grade II and 23.2% had grade III histology. Fifty-five patients had a gross total (GTR) or near total resection (NTR) at diagnosis and were observed (52.7%) or irradiated (43.6%); 60 patients had subtotal resection (STR) or biopsy (Bx) and were observed (40%) or irradiated (60%). Few patients (7.2%) received adjuvant chemotherapy; these were predominantly children age <8 years and had