Adjuvant Therapies for Infratentorial Ependymomas in Children

Radiation

• Standard postoperative treatment for posterior fossa ependymomas: Radiation therapy is a standard adjunctive modality, which decreases the rate of recurrence.  Doses of 4500–5600 cGy to the primary site significantly improves the overall survival rate and duration of disease-free survival (15). Radiation therapy in infants may be delayed with the use of chemotherapy.
• Surgical bed only for most cases: In cases with nondisseminated low-grade infratentorial ependymomas, radiotherapy is recommended to the local field rather than the entire posterior fossa (2, 18). If there are no radiographically evident metastases, there is no evidence that prophylactic craniospinal radiation improves outcomes (13).  Most spinal seeding occurs only after recurrence at the primary site, and craniospinal irradiation has not been shown to prevent spinal metastases.
• Craniospinal treatment for anaplastic infratentorial ependymomas: Anaplastic infratentorial ependymomas should be treated with craniospinal irradiation (2, 18).

Chemotherapy

• Chemotherapy considered for children < 2 to 3 years old: Due to the complications associated with radiotherapy in younger patients, more aggressive chemotherapy regimens are advised. Chemotherapy can transiently reduce or stabilize tumor burden in patients with recurrent disease and delay radiation therapy (16, 17).