Table 2 Recommendations for the treatment of intracranial and spinal grades II and III ependymomas in adults [28]
From: Extensive anaplastic multi-centric ependymoma in a young adult: case report and literature review
Recommendations | Intracranial | Spinal |
|---|---|---|
Gross total resection is the goal of the surgery | + | + |
Postoperative MRI should be performed to evaluate the extent of resection | + | + |
A second-look surgery should be considered when the result of the first resection has not been satisfactory | + | − |
Because a risk of CSF dissemination exists for all patients with newly diagnosed ependymoma, disease staging, including both craniospinal MRI and CSF cytology, is mandatory following surgery (not earlier than 2–3 weeks) | + | + |
Postoperative conformal radiotherapy is recommended for patients with WHO grade III (anaplastic) ependymomas regardless of the extent of resection The recommended doses are, respectively, 60 Gy and 45–54 Gy for intracranial and spinal grade III ependymomas | + | + |
Postoperative conformal radiotherapy is recommended for patients with WHO grade II ependymomas following incomplete resection The recommended doses are, respectively, 54–59.4 Gy and 45–54 Gy for intracranial and spinal grade II ependymomas | + | + |
Craniospinal irradiation of 36 Gy is recommended in case of CSF or spinal dissemination with a boost up to 45–54 Gy on focal lesions | + | − |
Because of the risk of asymptomatic and/or late relapses, patients should be followed long term with contrast-enhanced MRI | + | + |