From the Guidelines
The standard treatment for ependymoma typically involves maximal safe surgical resection followed by radiation therapy, as recommended by the European Association of Neuro-Oncology guidelines 1. Surgery aims to remove as much of the tumor as possible while preserving neurological function, with complete resection being the most important prognostic factor. After surgery, focal radiation therapy (54-59.4 Gy) is usually administered to the tumor bed, particularly for higher-grade tumors or those with incomplete resection. For young children under 3 years, radiation may be delayed to avoid neurocognitive effects, with chemotherapy sometimes used in the interim. Chemotherapy generally plays a limited role in initial treatment but may be considered for recurrent disease, with regimens including platinum agents (cisplatin, carboplatin), cyclophosphamide, etoposide, and vincristine. Some key points to consider in the treatment of ependymoma include:
- The importance of gross total resection (GTR) in improving outcomes, as noted in studies 1.
- The use of postoperative radiotherapy to improve local control and survival rates, as shown in studies 1.
- The limited role of chemotherapy in initial treatment, but its potential use in recurrent disease, as discussed in studies 1.
- The need for individualized treatment decisions based on tumor location, grade, extent of resection, patient age, and performance status, as emphasized in guidelines 1.
- The importance of regular follow-up with MRI scans to monitor for recurrence, as ependymomas can recur locally or spread through the cerebrospinal fluid, as noted in studies 1. Treatment decisions should be made on a case-by-case basis, taking into account the specific characteristics of the tumor and the patient's overall health, as recommended by the European Association of Neuro-Oncology guidelines 1.
From the Research
Standard Treatment for Ependymoma
The standard treatment for ependymoma typically involves a combination of therapies, including:
- Maximal surgical resection to remove as much of the tumor as possible 2, 3
- Focal radiation therapy, which may be used depending on the presence of residual disease and tumor grade 2, 4
- Chemotherapy, which may be considered in certain cases, such as for infants to delay radiation or to improve resectability 2, 3
Role of Radiation Therapy
Radiation therapy plays a crucial role in the treatment of ependymoma, with:
- Conformal radiation therapy (CRT) being used to target the tumor with a high degree of precision 4
- Stereotactic radiosurgery (SRS) emerging as a potential alternative for recurrent or residual cases 5, 6
- Radiation therapy being used to improve local tumor control and overall survival rates 4, 5, 6
Factors Influencing Treatment Outcomes
Several factors can influence treatment outcomes for ependymoma, including: