Supplementary Material for: Stereotactic Radiosurgery for Pediatric and Adult Intracranial and Spinal Ependymomas

Objective/Background: We report efficacy and toxicity outcomes with stereotactic radiosurgery (SRS) for intracranial and spinal ependymoma. Methods: We analyzed adult and pediatric patients with newly diagnosed or recurrent intracranial or spinal ependymoma lesions treated with SRS at our institution. Following SRS, local failure (LF) was defined as failure within or adjacent to the SRS target volume, while distant failure (DF) was defined as failure outside of the SRS target volume. Time to LF and DF was analyzed using competing risk analysis with death as a competing risk.Overall survival (OS) was calculated from the date of first SRS to the date of death or censored at the date of last follow-up using the Kaplan-Meier method. Results: Twenty-one patients underwent SRS to 40 intracranial (n = 30) or spinal (n = 10) ependymoma lesions between 2007 and 2018, most commonly with 18 or 20 Gy in 1 fraction. Median follow-up for all patients after first SRS treatment was 54 months (range 2–157). The 1-year, 2-year, and 5-year rates of survival among patients with initial intracranial ependymoma were 86, 74, and 52%, respectively. The 2-year cumulative incidences of LF and DF after SRS among intracranial ependymoma patients were 25% (95% CI 11–43) and 42% (95% CI 22–60), respectively. No spinal ependymoma patient experienced LF, DF, or death within 2 years of SRS. Three patients had adverse radiation effects. Conclusions: SRS is a viable treatment option for intracranial and spinal ependymoma with excellent local control and acceptable toxicity.

研究目的/背景：本研究报道颅内与脊髓室管膜瘤接受立体定向放射外科（Stereotactic Radiosurgery, SRS）治疗后的疗效与毒性反应结局。方法：本研究纳入本机构中接受SRS治疗的新发或复发颅内、脊髓室管膜瘤病灶的成人与儿童患者进行分析。SRS治疗后，局部失败（Local Failure, LF）定义为SRS靶体积内或邻近区域出现病灶进展，远处失败（Distant Failure, DF）定义为SRS靶体积外出现病灶进展。以死亡为竞争风险，采用竞争风险分析（Competing Risk Analysis）对局部失败与远处失败的发生时间进行分析。总生存期（Overall Survival, OS）定义为从首次SRS治疗至死亡的时间，采用Kaplan-Meier法计算，截尾时间为末次随访日期。结果：2007年至2018年间，共21例患者的40处颅内（n = 30）或脊髓（n = 10）室管膜瘤病灶接受SRS治疗，其中最常采用单次18 Gy或20 Gy的照射剂量。所有患者首次SRS治疗后的中位随访时间为54个月（范围2–157个月）。初发颅内室管膜瘤患者的1年、2年及5年总生存率分别为86%、74%与52%。颅内室管膜瘤患者在SRS治疗后2年的局部失败与远处失败累积发生率分别为25%（95% CI 11–43）与42%（95% CI 22–60）。脊髓室管膜瘤患者在SRS治疗后2年内均未出现局部失败、远处失败或死亡病例。共有3例患者出现放射性不良反应。结论：立体定向放射外科是治疗颅内与脊髓室管膜瘤的可行方案，其局部控制效果优异，毒性反应可接受。