DEFERRING ADJUVANT THERAPY FOR TOTALLY RESECTED INTRACRANIAL EPENDYMOMA

Radical surgery is the most important treatment modality for ependymom a, The benefit of adjuvant radiotherapy and/or chemotherapy following a gross total resection of a low grade intracranial ependymoma is unce rtain, Since 1990 we elected to defer adjuvant therapy in 7 pediatric patients with a median age of 7 years (range 3-16 years) who had a rad ical resection of an intracranial ependymoma and no evidence of centra l nervous system metastases, The primary tumor site was the cerebral h emisphere (6) and the cerebellum (1), A gross total resection was radi ologically confirmed in 5 of the 7 patients, Two of the patients had a blood clot in the resection site on the postoperative magnetic resona nce imaging scan, All patients are alive after a median follow-up of 4 4 months and the median progression-free survival is 38+ months, Five of the patients remain in continuous remission, The 2 patients with po stoperative blood clots developed subclinical local recurrences, 10 an d 11 months, respectively, after diagnosis, They remain in remission f or 13+ and 27+ months after subsequent radical surgical procedures, In volved field radiotherapy was administered to 1 patient, After a limit ed period of follow-up, radical surgery alone appears to be sufficient for the majority of children with low grade ependymomas diagnosed at >3 years of age when postoperative imaging confirms a gross total rese ction, This is more likely to occur in supratentorial ependymomas aris ing in older children.