Deferring adjuvant therapy for totally resected intracranial ependymoma

Radical surgery is the most important treatment modality for ependymoma, The benefit of adjuvant radiotherapy and/or chemotherapy following a gross total resection of a low grade intracranial ependymoma is uncertain, 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 radical resection of an intracranial ependymoma and no evidence of central nervous system metastases, The primary tumor site was the cerebral hemisphere (6) and the cerebellum (1), A gross total resection was radiologically confirmed in 5 of the 7 patients, Two of the patients had a blood clot in the resection site on the postoperative magnetic resonance imaging scan, All patients are alive after a median follow-up of 44 months and the median progression-free survival is 38+ months, Five of the patients remain in continuous remission, The 2 patients with postoperative blood clots developed subclinical local recurrences, 10 and 11 months, respectively, after diagnosis, They remain in remission for 13+ and 27+ months after subsequent radical surgical procedures, Involved field radiotherapy was administered to 1 patient, After a limited 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 resection, This is more likely to occur in supratentorial ependymomas arising in older children.