Ependymoma in children and young adults (0-19 years): report of 25 consecutive cases

The objective of this, retrospective study was to evaluate the relative eff ect of surgery and radiotherapy (RT) on the survival of 25 consecutive chil dren and young adults treated for ependymoma [18 in the posterior fossa (PF ), 2 in supratentorial locations (ST) and 5 in intraspinal locations (IS)]. Five-year survival rates for patients with PF, ST and IS tumors were 28%, 0% and 100%, respectively. Total tumor resection was a positive prognostic factor in the case of PF tumors. No patients with subtotal removal of a PF tumor survived for longer than 5 years. The effect of RT on survival of pat ients with PF ependymomas in this series was uncertain. No patients with PF ependymoma had disseminated disease at diagnosis, and all tumor recurrence s were local. Based on these observations, we see no indications for cranio spinal RT of PF ependymomas, except in rare cases of disseminated disease. If RT is given, it should only be targeted to the tumor site. The two patie nts with ST ependymoma died within 3.8 years after primary treatment. Our s eries of ST ependymomas does not allow any specific treatment recommendatio ns. One patient with IS ependymoma was cured by surgery alone. Four patient s with IS ependymoma had documented residual tumor after surgery. RT induce d remission in these patients. For IS ependymomas we recommend no RT if tot al tumor removal can be documented. In patients with subtotal removal of IS ependymomas local RT is effective and should be given.