What is the recommended adjuvant treatment for an adult patient with a subtotally resected infratentorial ependymoma with negative CSF and no spinal dissemination?
Central Nervous System
Epenydmomas are glial neoplasms that account for 5% of adult intracranial tumors. The mean age of presentation is in the third and fourth decades for adult patients. Spinal CSF analysis, and a brain and spine MRI are indicated for staging. Patients with gross totally resected tumors are offered irradiation, usually to a dose of 50.4-59.4 Gy to the preoperative tumor volume with a 1-2 cm margin. The outcomes of subtotally resected tumors are quite poor, and these patients are usually offered adjuvant radiation therapy. Rogers et al. JNS 2005 reviewed the Barrow Neurologic Institute results with radiation for adult infratentorial ependymoma, the results of which appear below.
10 yr LC 10 yr OS
GTR alone 50% 67%
GTR + RT 100% 83%
STR + RT 36% 43%
*GTR = gross total resection; LC = local control; OS = overall survival; RT = radiation therapy; STR = subtotal resection
This data led the authors to recommend radiation therapy for patients even with gross total resections.
Craniospinal radiation is recommended for patients with CSF positivity or craniospinal dissemination. The usual dose of CSI in this setting is 30.6-36 Gy followed by a focal boost to 54-59.4 Gy.