Grade I and II Ependymal Tumors

Ependymomas (World Health Organization [WHO] grade II) and WHO grade I ependymal tumors, i.e., subependymoma and myxopapillary ependymomas, are often curable. (Refer to the Ependymal tumors section in the classification section of this summary for more information.)

STANDARD TREATMENT OPTIONS:

1. Surgery alone if the tumor is totally resectable.
2. Surgery followed by radiation therapy to known or suspected residual tumor.[1,2]

TREATMENT OPTIONS UNDER CLINICAL EVALUATION:

• At recurrence following surgery, patients should be considered for reoperation and radiation therapy if not previously given. Patients who have received radiation therapy should be considered candidates for nitrosourea-based chemotherapies and for clinical trials that evaluate new drugs and biological response modifiers.

Anaplastic Ependymoma

Anaplastic ependymomas (WHO grade III) have variable prognoses that depend on the location and extent of disease. Frequently, but not invariably, anaplastic ependymomas have worse prognoses than lower grade ependymal tumors. (Refer to the Anaplastic ependymoma section in the Classification section of this summary for more information.)

STANDARD TREATMENT OPTIONS:

• Surgery plus radiation therapy.[1,2,3]

TREATMENT OPTIONS UNDER CLINICAL EVALUATION:

• Adjuvant chemotherapy before, during, and after radiation are treatment options being evaluated. At recurrence, patients should be considered candidates for nitrosourea-based chemotherapies and for clinical trials that evaluate new drugs and biological response modifiers.

Information about ongoing clinical trials is available from the NCI Web site.

References:

1. Wallner KE, Wara WM, Sheline GE, et al.: Intracranial ependymomas: results of treatment with partial or whole brain irradiation without spinal irradiation. Int J Radiat Oncol Biol Phys 12 (11): 1937-41, 1986.
2. Shaw EG, Evans RG, Scheithauer BW, et al.: Postoperative radiotherapy of intracranial ependymoma in pediatric and adult patients. Int J Radiat Oncol Biol Phys 13 (10): 1457-62, 1987.
3. Oya N, Shibamoto Y, Nagata Y, et al.: Postoperative radiotherapy for intracranial ependymoma: analysis of prognostic factors and patterns of failure. J Neurooncol 56 (1): 87-94, 2002.