Adjuvant Therapies for Ependymomas in Children

Chemotherapy

• Originally used in children under 3 years: Chemotherapy was originally considered for children younger than 3 years to defer onset of radiation therapy (17).
• Limited role at present: Cisplastin has a high response rate but little effect on survival. It is not a favored treatment now because tumors that progress during chemotherapy do not respond well to subsequent radiation, and a combination of chemotherapy and radiation does not improve overall survival (18). However, its use may make residual tumor more amenable to second-stage resection.

Radiation

Current standard adjuvant therapy

• Early (or immediate) postoperative radiation therapy improves outcome.
• Improves survival: Patients who underwent surgery plus postoperative radiation had better overall survival rates and progression-free survival rates compared to those who had surgery alone (19).
• Prophylactic craniospinal radiation is not beneficial.

Conformal radiation therapy

• Present standard of care, compared to previous conventional radiotherapy: Conformal radiation therapy offers the best local control, event-free survival, and overall survival rates. It can be safely used to treat children younger than 3 years (20, 21).
• Protective of surrounding tissue: The highest doses of radiation are limited to the primary site, and the dose to normal tissue is decreased. The radiation is focused on residual tumor volume with a 10-mm tumor margin.

Deferring radiation

• Historical approach: Several studies in the past (with small numbers of patients) advocated deferment of radiation if gross total resection had been achieved, or if the child was younger than 3 years (3, 4, 12).
• Risk requiring reoperation: However, 20–30% of the tumors recurred within 2 years and required repeat surgery and then radiation.
• Close radiological surveillance: Close radiological surveillance is required if radiation is deferred.

Immunotherapy

No role exists for immunotherapy at present.