Materiały źródłowe

• #1 Ependymoma: Diagnosis and Treatment – NCI

  https://www.cancer.gov/rare-brain-spine-tumor/tumors/ependymoma

  The first treatment for an ependymoma is surgery, if possible. The goal of surgery is to obtain tissue to determine the tumor type and remove as much tumor as possible without causing more symptoms. […] Many people won’t need additional treatment after surgery. For those that do, these treatments may include radiation, chemotherapy or clinical trials. Clinical trials test new chemotherapy, targeted therapy, or immunotherapy drugs. Treatments are decided by the patient’s health care team based on the patient’s age, remaining tumor after surgery, tumor type, and tumor location.

• #2 EANO guidelines for the diagnosis and treatment of ependymal tumors

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5909649/

  Ependymal tumors are rare CNS tumors and may occur at any age, but their proportion among primary brain tumors is highest in children and young adults. Thus, the level of evidence of diagnostic and therapeutic interventions is higher in the pediatric compared with the adult patient population. […] Surgery is the crucial initial treatment in both children and adults. In pediatric patients with intracranial ependymomas of WHO grades II or III, surgery is followed by local radiotherapy regardless of residual tumor volume. In adults, radiotherapy is employed in patients with anaplastic ependymoma WHO grade III, and in case of incomplete resection of WHO grade II ependymoma. […] A gross total resection is the mainstay of treatment in spinal ependymomas, and radiotherapy is reserved for incompletely resected tumors.

• #3 Ependymoma Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/277621-treatment

  The extent of tumor resection is the most important prognostic factor associated with long-term survival for patients with nonmalignant forms of ependymoma, regardless of location. Thus, a gross total resection (GTR) is optimal. The feasibility and extent of the resection will vary with the location of the tumor and the clinical characteristics of the patient. […] Resection is typically followed by histologic analysis and molecular testing to classify the tumor and guide prognostic estimates. Depending on the type of tumor, adjuvant treatment with radiation may be indicated. Currently, there are no ependymoma-specific molecular therapies, but this is an area of active research. […] Due to the risk of ependymoma recurrence, MRI surveillance typically follows treatment. […] Though surgical treatment is the primary treatment for ependymoma, medical management also plays a role. General medical management may include steroids for treatment of peritumoral edema and anticonvulsants. In the case of incomplete tumor resection or recurrence, radiation is central to medical management.

• #4

  https://link.springer.com/article/10.1007/s11912-022-01260-w

  Surgery is the first step of standard treatment. In the majority of studies, the extent of resection has emerged as one of the most significant predictors of outcome. In a retrospective series of WHO grade 2 ependymomas in adults, gross total resection (GTR) and infratentorial location were associated with a longer OS. GTR and tumor location were also independent factors predicting progression-free survival (PFS). Conversely, incomplete resection has an increased risk of tumor recurrence and CSF dissemination. However, in posterior fossa tumors, encasement of the cranial nerves and brainstem vasculature might limit extent of tumor resection. […] In adults, there is agreement that postoperative radiotherapy should be included in the standard of care for patients with anaplastic ependymoma (WHO grade 3) and for patients with ependymomas (WHO grade 2) after an incomplete resection. Conversely, the role of postoperative radiotherapy in patients with ependymoma WHO grade 2 undergoing GTR remains controversial.

• #5 Ependymoma – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538244/

  The extent of surgical resection for intracranial ependymomas has been the most reliable and consistent independent prognostic factor. […] Patients who undergo complete resection without signs of residual disease have presented a better outcome and overall survival compared to patients who undergo partial resection. For this reason, treatment typically consists of aggressive surgical excision. […] Across the different subgroups, infratentorial ependymomas generally have an excellent prognosis, even without treatment. Supratentorial ependymomas, however, often present a higher histological grade and have a lower survival rate despite treatment with resection and adjuvant radiation. […] The mainstay of treatment for ependymoma includes an interprofessional approach that may include surgery, radiation therapy, and chemotherapy.

• #6 Ependymoma Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/277621-treatment

  The extent of tumor resection is the most important prognostic factor associated with long-term survival for patients with nonmalignant forms of ependymoma, regardless of location. Thus, a gross total resection (GTR) is optimal. The feasibility and extent of the resection will vary with the location of the tumor and the clinical characteristics of the patient. […] Resection is typically followed by histologic analysis and molecular testing to classify the tumor and guide prognostic estimates. Depending on the type of tumor, adjuvant treatment with radiation may be indicated. Currently, there are no ependymoma-specific molecular therapies, but this is an area of active research. […] Due to the risk of ependymoma recurrence, MRI surveillance typically follows treatment. […] Though surgical treatment is the primary treatment for ependymoma, medical management also plays a role. General medical management may include steroids for treatment of peritumoral edema and anticonvulsants. In the case of incomplete tumor resection or recurrence, radiation is central to medical management.

• #7 Treatment for Adults | CERN Foundation

  https://www.cern-foundation.org/education/treatment/treatment-for-adults

  Surgery serves two important purposes: (1) removes as much of the tumor as possible and (2) gives a biopsy (sample) of the type of the cells for diagnosis. […] External beam radiation treatment is often used to treat ependymoma. This treatment uses beams of X-rays, gamma rays or protons aimed from outside the head or spine at the tumor. The beam kills cancer cells and shrinks tumors. […] The standard therapy for low-grade ependymoma is complete surgical removal. If this cannot be safely done or if there are other concerns, radiation therapy is usually given after recovery from surgery. […] For patients with the more aggressive anaplastic ependymoma, the standard of care is to attempt a complete removal of tumor by surgery. After surgery, radiation is usually given to the area of tumor. Chemotherapy may be given in addition to radiation.

• #8

  https://link.springer.com/article/10.1007/s11912-022-01260-w

  Surgery is the first step of standard treatment. In the majority of studies, the extent of resection has emerged as one of the most significant predictors of outcome. In a retrospective series of WHO grade 2 ependymomas in adults, gross total resection (GTR) and infratentorial location were associated with a longer OS. GTR and tumor location were also independent factors predicting progression-free survival (PFS). Conversely, incomplete resection has an increased risk of tumor recurrence and CSF dissemination. However, in posterior fossa tumors, encasement of the cranial nerves and brainstem vasculature might limit extent of tumor resection. […] In adults, there is agreement that postoperative radiotherapy should be included in the standard of care for patients with anaplastic ependymoma (WHO grade 3) and for patients with ependymomas (WHO grade 2) after an incomplete resection. Conversely, the role of postoperative radiotherapy in patients with ependymoma WHO grade 2 undergoing GTR remains controversial.

• #9 Ependymoma Diagnosis & Treatment – NYC | Columbia Neurosurgery in New York City

  https://www.neurosurgery.columbia.edu/patient-care/conditions/ependymoma

  Ependymomas are brain tumors that arise from ependymal cells. The most common surgical treatment for ependymoma is craniotomy and surgical removal, and the most common nonsurgical treatment is stereotactic radiosurgery. […] The standard surgical treatment for these tumors is brain tumor surgery. To surgically resect the tumor, a neurosurgeon performs a craniotomy, providing access to the tumor. […] The outcome of surgery largely depends on the extent of tumor resection. Complete resection is the goal, but sometimes the tumor is attached to, or too near, critical structures, making complete resection impossible. Instead, subtotal resection is performed. Our neurosurgeons remove as much tumor as possible while also preserving nearby structures and overall function. […] Adjuvant treatment with radiotherapy is used to treat residual tumor and tumor recurrence. However, physicians avoid radiotherapy in children younger than three years old because of the risk of negative effects on the developing brain. Instead, chemotherapy may be used for these young children and then radiotherapy used once they are older. […] Radiotherapy can be administered in a variety of ways, one of which is stereotactic radiosurgerya noninvasive, highly precise means of delivering radiation to tumor cells.

• #10 Surgery for Ependymoma | Neurological Surgery

  https://neurosurgery.weillcornell.org/condition/ependymoma/surgery-ependymoma

  Surgery is the treatment of choice for ependymomas. […] For most ependymomas, however, the goal of surgery is to resect (remove) the tumor. An ependymoma may be resected entirely or in part, depending on its features and location. […] Depending on the type of ependymoma, especially if it is low grade, no further treatment may be necessary. Sometimes, especially with anaplastic ependymomas, further therapies are recommended following surgery, even if it appears the tumor was completely removed. […] Radiation therapy can reduce the chance of recurrence in this type of aggressive ependymoma. […] Chemotherapy may be beneficial in patients with high-grade ependymomas that recur, especially in the era of immunotherapy. […] Advances in microsurgical techniques and high-quality imaging have greatly improved the prognosis for removal of ependymomas.

• #11 Surgery for Ependymoma | Neurological Surgery

  https://neurosurgery.weillcornell.org/condition/ependymoma/surgery-ependymoma

  Although traditional neurosurgery for ependymomas in the brain relied heavily on open surgery such as craniotomies and craniectomies, today’s neurosurgeons are more likely to use whisper-thin tools that require smaller incisions and less trauma and that allow for faster recovery times. […] Neurosurgeons use stereotactic radiosurgery for precise delivery of highly focused radiation that can pinpoint an ependymoma tumor or other target with little or no effect on normal surrounding tissue. […] In many brain tumor operations, patients can now benefit from intraoperative fluorescence using 5-ALA technology. Using this novel treatment, surgeons have a new way of visualizing brain tumors separately from healthy brain tissue, thereby maximizing the degree of brain tumor removal.

• #12

  https://link.springer.com/article/10.1007/s11912-022-01260-w

  Spinal ependymoma (grade 2 or 3) has a better outcome than spinal astrocytoma. GTR offers the best prognosis. Advances in microsurgical techniques allow en bloc GTR over piecemeal subtotal resection (STR) as standard of care for spinal ependymomas with good functional results. Resection should be considered at an early stage of the disease as functional outcome is related to small tumor size and good neurological status at the time of surgery.

• #13

  https://link.springer.com/article/10.1007/s11912-022-01260-w

  Spinal ependymoma (grade 2 or 3) has a better outcome than spinal astrocytoma. GTR offers the best prognosis. Advances in microsurgical techniques allow en bloc GTR over piecemeal subtotal resection (STR) as standard of care for spinal ependymomas with good functional results. Resection should be considered at an early stage of the disease as functional outcome is related to small tumor size and good neurological status at the time of surgery.

• #14 Surgery for Ependymoma | Neurological Surgery

  https://neurosurgery.weillcornell.org/condition/ependymoma/surgery-ependymoma

  Although traditional neurosurgery for ependymomas in the brain relied heavily on open surgery such as craniotomies and craniectomies, today’s neurosurgeons are more likely to use whisper-thin tools that require smaller incisions and less trauma and that allow for faster recovery times. […] Neurosurgeons use stereotactic radiosurgery for precise delivery of highly focused radiation that can pinpoint an ependymoma tumor or other target with little or no effect on normal surrounding tissue. […] In many brain tumor operations, patients can now benefit from intraoperative fluorescence using 5-ALA technology. Using this novel treatment, surgeons have a new way of visualizing brain tumors separately from healthy brain tissue, thereby maximizing the degree of brain tumor removal.

• #15 EANO guidelines for the diagnosis and treatment of ependymal tumors

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5909649/

  Concepts regarding target volume for radiation therapy have evolved. In the past, patients with ependymoma often received craniospinal irradiation. However, numerous studies demonstrated the efficacy of local fields in the treatment of ependymoma, achieving good local control with low risk of spinal dissemination. […] In adults, there is agreement that postoperative radiotherapy should be included in the standard of care for patients with anaplastic ependymoma (WHO grade III) and for patients with ependymomas (WHO grade II) after an incomplete resection. […] The benefit of postoperative radiotherapy has been shown in terms of local control and survival rates in children with intracranial ependymomas. […] Postoperative radiotherapy with 59.4 Gy (1.8 Gy/fraction) has been advocated for children older than 3 years, while for children as young as 18 months or children with altered neurological status, the doses can be lowered to 54 Gy.

• #16 EANO guidelines for the diagnosis and treatment of ependymal tumors

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5909649/

  Concepts regarding target volume for radiation therapy have evolved. In the past, patients with ependymoma often received craniospinal irradiation. However, numerous studies demonstrated the efficacy of local fields in the treatment of ependymoma, achieving good local control with low risk of spinal dissemination. […] In adults, there is agreement that postoperative radiotherapy should be included in the standard of care for patients with anaplastic ependymoma (WHO grade III) and for patients with ependymomas (WHO grade II) after an incomplete resection. […] The benefit of postoperative radiotherapy has been shown in terms of local control and survival rates in children with intracranial ependymomas. […] Postoperative radiotherapy with 59.4 Gy (1.8 Gy/fraction) has been advocated for children older than 3 years, while for children as young as 18 months or children with altered neurological status, the doses can be lowered to 54 Gy.

• #17

  https://link.springer.com/article/10.1007/s11912-022-01260-w

  Surgery is the first step of standard treatment. In the majority of studies, the extent of resection has emerged as one of the most significant predictors of outcome. In a retrospective series of WHO grade 2 ependymomas in adults, gross total resection (GTR) and infratentorial location were associated with a longer OS. GTR and tumor location were also independent factors predicting progression-free survival (PFS). Conversely, incomplete resection has an increased risk of tumor recurrence and CSF dissemination. However, in posterior fossa tumors, encasement of the cranial nerves and brainstem vasculature might limit extent of tumor resection. […] In adults, there is agreement that postoperative radiotherapy should be included in the standard of care for patients with anaplastic ependymoma (WHO grade 3) and for patients with ependymomas (WHO grade 2) after an incomplete resection. Conversely, the role of postoperative radiotherapy in patients with ependymoma WHO grade 2 undergoing GTR remains controversial.

• #18 EANO guidelines for the diagnosis and treatment of ependymal tumors

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5909649/

  Concepts regarding target volume for radiation therapy have evolved. In the past, patients with ependymoma often received craniospinal irradiation. However, numerous studies demonstrated the efficacy of local fields in the treatment of ependymoma, achieving good local control with low risk of spinal dissemination. […] In adults, there is agreement that postoperative radiotherapy should be included in the standard of care for patients with anaplastic ependymoma (WHO grade III) and for patients with ependymomas (WHO grade II) after an incomplete resection. […] The benefit of postoperative radiotherapy has been shown in terms of local control and survival rates in children with intracranial ependymomas. […] Postoperative radiotherapy with 59.4 Gy (1.8 Gy/fraction) has been advocated for children older than 3 years, while for children as young as 18 months or children with altered neurological status, the doses can be lowered to 54 Gy.

• #19 EANO guidelines for the diagnosis and treatment of ependymal tumors

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5909649/

  Concepts regarding target volume for radiation therapy have evolved. In the past, patients with ependymoma often received craniospinal irradiation. However, numerous studies demonstrated the efficacy of local fields in the treatment of ependymoma, achieving good local control with low risk of spinal dissemination. […] In adults, there is agreement that postoperative radiotherapy should be included in the standard of care for patients with anaplastic ependymoma (WHO grade III) and for patients with ependymomas (WHO grade II) after an incomplete resection. […] The benefit of postoperative radiotherapy has been shown in terms of local control and survival rates in children with intracranial ependymomas. […] Postoperative radiotherapy with 59.4 Gy (1.8 Gy/fraction) has been advocated for children older than 3 years, while for children as young as 18 months or children with altered neurological status, the doses can be lowered to 54 Gy.

• #20 Ependymoma Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/277621-treatment

  Following incomplete resection, adjuvant conformal radiation treatment is the mainstay of medical treatment for supratentorial ependymoma for patients over the age of 18 months. […] Subtotal resection can be associated with increased rates of local recurrence, but adjuvant radiation therapy may be useful in limiting this effect, and the current standard of care for posterior fossa ependymomas includes conformal radiation therapy. […] Adjuvant radiation therapy for spinal ependymoma varies based on the grade and recurrence status of the tumor. Adjuvant radiation therapy is not required if the spinal ependymoma if there is no evidence of metastasis and the grade of the tumor is WHO grade 2 or less. All grade 3 spinal ependymomas receive radiation therapy. […] Regardless of subtype or molecular characteristics, the primary treatment modality for ependymoma is surgical resection. Across subtypes, extent of resection is one of the strongest predictors of overall survival.

• #21 Current Management of Childhood Ependymoma

  https://www.cancernetwork.com/view/current-management-childhood-ependymoma

  Although complete resection is instrumental in the long-term, event-free, and overall survival of patients with childhood ependymoma, it is performed in only 42% to 62% of patients. […] Current management of childhood ependymoma relies on three principal classifications of resection. […] For nearly 20 years, the avoidance of radiation therapy has been the hallmark of trial designs for the treatment of brain tumors in young children. […] Since 1977, postoperative radiation therapy has been considered standard treatment for patients with ependymoma. […] The optimal dose of radiation remains unclear. […] The recent POG 9132 study used hyperfractionated radiation therapy delivered to the primary site at a total dose of 6,960 cGy for the treatment of posterior fossa ependymoma. […] Conformal radiation therapy limits the highest doses to the primary site and decreases the dose received by normal tissues.

• #22 Ependymoma Diagnosis & Treatment – NYC | Columbia Neurosurgery in New York City

  https://www.neurosurgery.columbia.edu/patient-care/conditions/ependymoma

  Ependymomas are brain tumors that arise from ependymal cells. The most common surgical treatment for ependymoma is craniotomy and surgical removal, and the most common nonsurgical treatment is stereotactic radiosurgery. […] The standard surgical treatment for these tumors is brain tumor surgery. To surgically resect the tumor, a neurosurgeon performs a craniotomy, providing access to the tumor. […] The outcome of surgery largely depends on the extent of tumor resection. Complete resection is the goal, but sometimes the tumor is attached to, or too near, critical structures, making complete resection impossible. Instead, subtotal resection is performed. Our neurosurgeons remove as much tumor as possible while also preserving nearby structures and overall function. […] Adjuvant treatment with radiotherapy is used to treat residual tumor and tumor recurrence. However, physicians avoid radiotherapy in children younger than three years old because of the risk of negative effects on the developing brain. Instead, chemotherapy may be used for these young children and then radiotherapy used once they are older. […] Radiotherapy can be administered in a variety of ways, one of which is stereotactic radiosurgerya noninvasive, highly precise means of delivering radiation to tumor cells.

• #23 Here’s the Ultimate Guide to Treating An Ependymoma Brain Tumor – GoMedii Blog

  https://gomedii.com/blogs/english/health-a2z/heres-the-ultimate-guide-to-treating-an-ependymoma-brain-tumor/

  Surgery is the most effective option for ependymoma patients. Neurosurgeons use advanced techniques to remove tumors. They aim to remove as much as possible while keeping the tissue and nerves surrounding around your brain and spine safe. The goal is to improve the patients chances of recovery and quality of life […] Radiation therapy is a significant and effective component of ependymoma treatment. It uses targeted radiation, like IMRT and stereotactic radiosurgery, to kill tumor cells left after surgery. […] Chemotherapy might be used for aggressive or recurring tumors. Oncologists choose the right chemotherapy based on the tumor and the patients health. It can be used alone or with other treatment protocols.

• #24

  https://link.springer.com/article/10.1007/s11912-022-01260-w

  Ependymomas may occur either in the brain or in the spinal cord. Compared with intracranial ependymomas, spinal ependymomas are less frequent and exhibit a better prognosis. The majority of studies have shown a major impact of extent of resection; thus, a complete resection must be performed, whenever possible, at first surgery or at reoperation. Conformal radiotherapy is recommended for grade 3 or incompletely resected grade II tumors. Proton therapy is increasingly employed especially in children to reduce the risk of neurocognitive and endocrine sequelae. Chemotherapy is not useful as primary treatment and is commonly employed as salvage treatment for patients failing surgery and radiotherapy. […] Standard treatments are still the mainstay of treatment: the discovery of new druggable pathways will hopefully increase the therapeutic armamentarium in the near future.

• #25 Childhood Ependymoma Treatment (PDQ®): Treatment – Health Professional Information [NCI] – Health Information Library | PeaceHealth

  https://www.peacehealth.org/medical-topics/id/ncicdr0000062843

  The rationale for radiation therapy, as described in the Treatment of no residual disease, no disseminated disease section above, also pertains to the treatment of children with residual nondisseminated ependymoma. […] Patients with recurrent ependymomas should be considered for treatment with focal retreatment with various radiation modalities, including stereotactic radiosurgery, intensity-modulated photon therapy, and proton therapy. […] The utility of further surgical intervention is individualized, based on the extent and location of the tumor. A study of 53 patients with recurrent ependymoma demonstrated an improved 5-year overall survival rate of 48.7% for patients who had gross-total or near-total resections at the time of surgery, compared with 5.3% for patients with less than gross-total or near-total resections.

• #26

  https://link.springer.com/article/10.1007/s11912-022-01260-w

  The benefit of postoperative radiotherapy for incompletely resected ependymomas in terms of local control and overall survival rates is clear. […] The toxicity of radiotherapy in younger children is of concern, and intensity-modulated radiation therapy is employed to limit late sequelae. Proton therapy could be an alternative to conventional photon radiotherapy for toxicity reduction. […] The role of chemotherapy in children remains unproven despite intensive investigation. […] Thus far, no targeted therapies are available in ependymomas. A recent preclinical study has suggested FGFR inhibition as a novel approach to target aggressive ependymomas. […] The extent of resection at recurrence appears important in improving the outcome. A recent study in children and adolescents has reported that gross- and near-total resection were achieved in 64% of patients and were associated with an improved 5-year survival (OS) of 48.7% vs 5.3% in less than gross total or near-total resection.

• #27 Ependymoma Brain Tumor Symptoms and Treatment | UPMC

  https://www.upmc.com/services/neurosurgery/brain/conditions/brain-tumors/ependymoma

  Ependymomas are generally resistant to chemotherapy, so their surgical removal is a mainstay of treatment. […] At UPMC, Gamma Knife radiosurgery may also be a treatment option. […] Your neurosurgical team at UPMC may recommend a combination of surgical and non-surgical approaches to ependymoma treatment. […] Whenever possible, ependymomas are surgically removed. […] Gamma Knife treatment may be an option for people with residual tumor after surgery or recurrent ependymoma brain tumors. Gamma Knife radiosurgery is a method to non-invasively boost the effectiveness of radiation delivered to the tumor. […] If surgery isn’t an option for your ependymoma, you may receive radiation therapy.

• #28 Ependymoma – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538244/

  Ependymal tumors are rare, constituting 1.7% of all brain tumors, as reported in the most recent CBTRUS statistical report; this poses a challenge in defining the optimal management for these entities. […] Retrospective studies have described improved survival in patients undergoing resection with adjuvant radiation therapy. There is minimal and limited evidence supporting chemotherapy for adult ependymomas. […] The current consensus, however, recommends that patients with PF-EPN-A positive ependymoma, who are older than 12 months of age, undergo maximal safe micro-neurosurgical removal in addition to local radiotherapy. […] For intracranial ependymomas, surgery is typically the mainstay treatment. Complete resection without residual disease has presented better clinical outcomes and overall survival than partial resection. As discussed previously, there is insufficient evidence to support the use of chemotherapy.

• #29 Observation and Medical Management for Ependymoma | Expert Surgeon | Aaron Cohen-Gadol, MD

  https://www.aaroncohen-gadol.com/en/patients/ependymoma/treatment/medications

  In certain cases, anti-cancer medicines (chemotherapy) may be used to treat the ependymoma. Currently, the role of chemotherapy in treating ependymoma is limited and reserved for infants or patients who have failed all other treatment options. Young children under 18 months old are typically treated with chemotherapy rather than radiotherapy because of their increased vulnerability to severe side effects and the potential long-term impact of radiation on cognitive functions. […] Chemotherapy is provided in cycles of treatment. One cycle of treatment is the time between the start of one round of chemotherapy and the start of the next one. For example, if you have 1 week of chemotherapy followed by a 3-week break without chemotherapy, this would be one cycle of treatment lasting 4 weeks. […] The response of an ependymoma to chemotherapy can be hard to predict. Because the effectiveness of treatment is limited, chemotherapy is considered as a treatment option when all other options have been exhausted or if the patient cannot tolerate the side effects of other treatments.

• #30 Ependymoma: Symptoms, Treatment, Prognosis & Types

  https://my.clevelandclinic.org/health/diseases/23147-ependymoma

  Youll probably need surgery to remove the tumor. You might need other treatments like radiation or chemotherapy, too. […] Your healthcare provider will treat an ependymoma with: […] Surgery is the most common ependymoma treatment. A surgeon will remove as much of the tumor as possible. […] Radiation therapy uses powerful X-rays to destroy tumor cells. You might need radiation before and/or after surgery. […] Chemo is medication that kills cancer cells. Youll usually only need chemo if the tumor has spread to other areas of your body. This is very rare with ependymomas. […] Youll take medications that boost your immune systems ability to fight cancer. Immunotherapy is a rare treatment for an ependymoma. […] Theres no cure for cancer, but its possible to remove or destroy a grade 3 ependymoma with treatment. […] Remember, theres always a chance an ependymoma regrows (recurs), even after youve been declared cancer-free.

• #31 EANO guidelines for the diagnosis and treatment of ependymal tumors

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5909649/

  Recommendations regarding treatment of intracranial ependymomas in children are summarized in Tables 2, 3, and 4. […] Standard salvage options for recurrent ependymomas have not been identified. However, re-operation as well as re-irradiation are increasingly employed. […] The role of chemotherapy for treatment of recurrent ependymoma in adults remains unclear and is considered only when local treatment options (surgery and radiotherapy) have been exhausted. […] Recommendations regarding treatment of recurrent ependymomas are summarized in Table 3. […] Ependymal tumors of the spinal cord are more common in adults than in children. […] Advances in microsurgical techniques have allowed en bloc GTR over piecemeal subtotal resection (STR) as standard of care for spinal cord ependymomas. […] Recommendations regarding treatment of spinal cord ependymomas are summarized in Table 5.

• #32 Ependymoma > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/ependymoma

  Treatment includes surgery, chemotherapy, radiation therapy. […] An ependymoma can be treated, although the treatments effectiveness depends on the tumors location within the brain or spinal cord. The best outcomes occur when all or most of the tumor is removed. […] Surgery is typically recommended as the first-line treatment, except when the tumor is too large to be removed. In those cases, a patient may receive chemotherapy to shrink the tumor, followed by its surgical removal. […] Radiation therapy may be used after surgery to destroy any remaining cancer cells. For children under 12 months old, however, radiation therapy is typically not offered. […] Chemotherapy after surgery is generally not recommended or helpful for patients with an ependymoma. However, some doctors recommend chemotherapy for patients under 12 months old until they are old enough for radiation therapy.

• #33 Ependymoma Treatment | St. Jude Care & Treatment

  https://www.stjude.org/care-treatment/treatment/childhood-cancer/brain-tumors/ependymoma.html

  Ependymoma is often treated with surgery, followed by radiation. Traditional chemotherapy has been used to treat ependymoma, but the results are mixed and have not been beneficial. We are exploring other medicines to improve the survival of this disease. […] Current strategies include: Surgery to remove all or part of the tumor. Radiation using high-energy x-rays and other types of radiation to kill tumor cells and stop them from growing. Chemotherapy used along with surgery when tumors are difficult to remove. Chemotherapy can shrink the tumor to help brain surgeons (neurosurgeons) later fully remove the tumor before radiation. Medicines to help control symptoms and improve quality of life during treatment. […] Our brain tumor clinical trials have led to better therapies in children. These include lower-dose therapies, targeted therapy, and proton therapy. These treatments kill cancer cells while sparing healthy cells. They may lessen side effects that affect brain function after treatment for some types of brain tumors.

• #34 Current Management of Childhood Ependymoma

  https://www.cancernetwork.com/view/current-management-childhood-ependymoma

  Several retrospective reviews have assessed the effectiveness of chemotherapy in the treatment of newly diagnosed ependymoma, and none have found that it improves overall survival. […] Ependymoma does respond to some chemotherapeutic regimens. […] Chemotherapy may make residual tumors more amenable to complete surgical resection. […] The findings of Gaynon et al support the use of carboplatin for patients with ependymoma. […] A national treatment standard for all pediatric patients with intracranial ependymoma is needed. […] Local control is the primary treatment objective because local recurrence is the predominant mode of failure. […] The proposed schema of the next Childrens Oncology Group study to further investigate the current management of childhood ependymoma in a multi-institutional cooperative trial is diagrammed in Figure 12. […] Immediate postoperative conformal radiation therapy is recommended for the treatment of childhood ependymoma on the basis of the following criteria: Maximal resection of the primary tumor, including second resection to achieve gross total resection.

• #35

  https://link.springer.com/article/10.1007/s11912-022-01260-w

  The benefit of postoperative radiotherapy for incompletely resected ependymomas in terms of local control and overall survival rates is clear. […] The toxicity of radiotherapy in younger children is of concern, and intensity-modulated radiation therapy is employed to limit late sequelae. Proton therapy could be an alternative to conventional photon radiotherapy for toxicity reduction. […] The role of chemotherapy in children remains unproven despite intensive investigation. […] Thus far, no targeted therapies are available in ependymomas. A recent preclinical study has suggested FGFR inhibition as a novel approach to target aggressive ependymomas. […] The extent of resection at recurrence appears important in improving the outcome. A recent study in children and adolescents has reported that gross- and near-total resection were achieved in 64% of patients and were associated with an improved 5-year survival (OS) of 48.7% vs 5.3% in less than gross total or near-total resection.

• #36 Childhood Ependymoma Treatment (PDQ®): Treatment – Health Professional Information [NCI]

  https://www.myactivehealth.com/hwcontent/content/nci/ncicdr0000062843.html

  The standard treatment options for newly diagnosed childhood ependymoma (WHO Grade II), anaplastic ependymoma (WHO Grade III), or RELA fusion-positive ependymoma include the following: Surgery. Adjuvant therapy. […] The traditional postsurgical treatment for these patients has been radiation therapy consisting of 54 Gy to 59.4 Gy to the tumor bed for children aged 3 years and older. […] The rationale for radiation therapy as described in the Treatment options for no residual disease, no disseminated disease subsection above also pertains to the treatment of children with residual, nondisseminated ependymoma. […] Patients with recurrent ependymomas should be considered for treatment with the following modalities: Focal retreatment with various radiation modalities, including stereotactic radiosurgery, intensity-modulated photon therapy, and proton therapy. Active anticancer agents, including cyclophosphamide, cisplatin, carboplatin, lomustine, and etoposide. […] The need for further surgical intervention is individualized based on the following: Extent of the tumor. Length of time between initial treatment and the reappearance of the recurrent lesion. […] The role of chemotherapy in the management of children with disseminated ependymoma is unproven.

• #37 Current Management of Childhood Ependymoma

  https://www.cancernetwork.com/view/current-management-childhood-ependymoma

  Several retrospective reviews have assessed the effectiveness of chemotherapy in the treatment of newly diagnosed ependymoma, and none have found that it improves overall survival. […] Ependymoma does respond to some chemotherapeutic regimens. […] Chemotherapy may make residual tumors more amenable to complete surgical resection. […] The findings of Gaynon et al support the use of carboplatin for patients with ependymoma. […] A national treatment standard for all pediatric patients with intracranial ependymoma is needed. […] Local control is the primary treatment objective because local recurrence is the predominant mode of failure. […] The proposed schema of the next Childrens Oncology Group study to further investigate the current management of childhood ependymoma in a multi-institutional cooperative trial is diagrammed in Figure 12. […] Immediate postoperative conformal radiation therapy is recommended for the treatment of childhood ependymoma on the basis of the following criteria: Maximal resection of the primary tumor, including second resection to achieve gross total resection.

• #38 Ependymoma – Symptoms, Diagnosis, and TreatmentSecond Opinion IconGroup 9Second Opinion IconGroup 9Group 49

  https://www.barrowneuro.org/condition/ependymoma/

  In some cases, complete removal won’t be possible because of your tumor’s location. That said, a partial resection can still be beneficial and complemented by additional therapies like radiation. […] Radiation therapy uses precisely aimed beams of radiation to destroy tumors in the body. While it doesn’t remove the tumor, radiation therapy damages the DNA of the tumor cells, which then lose their ability to reproduce and eventually die. In grade 2 ependymomas, local radiation is used if some of the tumor remains after surgery. In grade 3 ependymomas, radiation is always given since this type of ependymoma is aggressive. If ependymoma cells are found in the CSF, radiation is given to the entire brain and spine, which is called craniospinal radiation. […] Chemotherapy is used for ependymomas when surgery and radiation do not control the cancer cells. Various chemotherapy regimens can be used, with the combination of the chemotherapies lapatinib and temozolomide having the most evidence of efficacy.

• #39 Myxopapillary Ependymoma Tumor | Dallas Plano Frisco TX Offices

  https://scoliosisinstitute.com/myxopapillary-ependymoma/

  After complete tumor excision, the long-term survival rate in adjuvant therapies, which combine radiation and surgery, was about 40 percent. […] The primary goal is to achieve complete resection of the tumor while preserving neurological function. However, the surgeon must exercise caution due to the tumors proximity to critical structures, such as the spinal cord and nerve roots. […] Surgical resection is considered the treatment for MPE, but adjuvant radiation therapy (RT) has helped prolong progression-free survival in pediatric and adult patients. […] Successful treatments for pediatric patients continue as a difficult challenge as they typically have lower outcomes. Even after GTR of the tumor, several publications recommend using adjuvant radiation in pediatric patients. […] Temozolomide, a drug used to treat glioblastoma, recently reported scientific information about it being effective with low-grade spinal cord gliomas, including spinal cord intramedullary ependymoma. However, at this time, scientists and doctors do not know if TMZ is effective for Myxopapillary Ependymoma.

• #40 Observation and Medical Management for Ependymoma | Expert Surgeon | Aaron Cohen-Gadol, MD

  https://www.aaroncohen-gadol.com/en/patients/ependymoma/treatment/medications

  In certain cases, anti-cancer medicines (chemotherapy) may be used to treat the ependymoma. Currently, the role of chemotherapy in treating ependymoma is limited and reserved for infants or patients who have failed all other treatment options. Young children under 18 months old are typically treated with chemotherapy rather than radiotherapy because of their increased vulnerability to severe side effects and the potential long-term impact of radiation on cognitive functions. […] Chemotherapy is provided in cycles of treatment. One cycle of treatment is the time between the start of one round of chemotherapy and the start of the next one. For example, if you have 1 week of chemotherapy followed by a 3-week break without chemotherapy, this would be one cycle of treatment lasting 4 weeks. […] The response of an ependymoma to chemotherapy can be hard to predict. Because the effectiveness of treatment is limited, chemotherapy is considered as a treatment option when all other options have been exhausted or if the patient cannot tolerate the side effects of other treatments.

• #41 Ependymoma Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/277621-treatment

  Postoperative imaging is recommended to determine the extent of surgical resection. […] A team of specialists including a neurologist, neurosurgeon, neurooncologist, and radiation oncologist should evaluate patients with ependymomas to develop a coordinated treatment strategy. […] Long-term monitoring of ependymoma patients with periodic brain/spine MRI is recommended following gross total resection. Current NCCN recommendations specify tumor site MRI once every 3-4 months during the first year following resection, then every 4-6 months during the second year, and every 6-12 months for 5-10 years. […] Following recurrence, repeat resection is recommended if possible. Depending on the extent of this resection, either system or craniospinal radiation therapy is recommended.

• #42 Ependymoma – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538244/

  The extent of surgical resection for intracranial ependymomas has been the most reliable and consistent independent prognostic factor. […] Patients who undergo complete resection without signs of residual disease have presented a better outcome and overall survival compared to patients who undergo partial resection. For this reason, treatment typically consists of aggressive surgical excision. […] Across the different subgroups, infratentorial ependymomas generally have an excellent prognosis, even without treatment. Supratentorial ependymomas, however, often present a higher histological grade and have a lower survival rate despite treatment with resection and adjuvant radiation. […] The mainstay of treatment for ependymoma includes an interprofessional approach that may include surgery, radiation therapy, and chemotherapy.

• #43 Ependymoma: Diagnosis and Treatment – NCI

  https://www.cancer.gov/rare-brain-spine-tumor/tumors/ependymoma

  The first treatment for an ependymoma is surgery, if possible. The goal of surgery is to obtain tissue to determine the tumor type and remove as much tumor as possible without causing more symptoms. […] Many people won’t need additional treatment after surgery. For those that do, these treatments may include radiation, chemotherapy or clinical trials. Clinical trials test new chemotherapy, targeted therapy, or immunotherapy drugs. Treatments are decided by the patient’s health care team based on the patient’s age, remaining tumor after surgery, tumor type, and tumor location.

• #44 Ependymoma Cancer Treatment | CERN Foundation

  https://www.cern-foundation.org/education/treatment

  To make the best ependymoma treatment decisions, you need to understand all of your options. […] Many factors impact decisions about the treatment of ependymoma including the tumor location and grade, and the age of the person. […] Your treating doctor will determine your treatment plan. […] Therefore, it is important for you to understand all options and possible side effects so you can make the best decision for yourself. […] One option may include a clinical trial. […] Partnering with your medical team is an important part of beginning your treatment path and determining your personal plan. […] At the CERN Foundation, we encourage all ependymoma patients to seek a medical opinion with neuro-oncologists that have experience with this disease.

• #45 Childhood Ependymoma Treatment (PDQ®): Treatment – Health Professional Information [NCI] – Health Information Library | PeaceHealth

  https://www.peacehealth.org/medical-topics/id/ncicdr0000062843

  Childhood ependymoma treatment begins with surgery. The type of adjuvant therapy given, such as a second surgery, chemotherapy, or radiation therapy, depends on the following: subtype of ependymoma, location of the tumor, whether the tumor was completely removed during the initial surgery, whether the tumor has disseminated throughout the central nervous system, and the child’s age. […] Standard treatment options for newly diagnosed childhood intracranial ependymoma include surgery and adjuvant therapy. Typically, all patients undergo surgery to remove the tumor. Whether additional treatment is given depends on the ependymoma subtype, age of the child, extent of tumor resection, and whether disseminated disease is present. […] The standard postsurgical treatment for patients with no residual disease and no disseminated disease has been radiation therapy consisting of 54 Gy to 59.4 Gy to the tumor bed for children aged 3 years and older.

• #46 Ependymoma – American Brain Tumor Association | Learn More

  https://www.abta.org/tumor_types/ependymoma/

  Ependymomas arise from the ependymal cells that line the ventricles of the brain and the center of the spinal cord. They are soft, grayish, or red tumors which may contain cysts or mineral calcifications. […] Common treatment options for ependymoma include surgery, radiation therapy, and in certain situations chemotherapy. However, different subtypes may be treated differently. Many patients won’t need additional treatment beyond surgery, depending on the tumor subtype and provided that the whole tumor is removed. For example, a subependymoma can be cured by surgery alone and does not typically recur if it is removed completely. If a patient with ependymoma needs more treatment after surgery, it would be either radiation therapy or chemotherapy. However, the role of chemotherapy remains unproven and is still being studied. For now, chemotherapy is often limited to the treatment of very young children and some adults with a recurrent tumor. […] The Collaborative Ependymoma Research Network (CERN) was developed to translate lab findings into clinical trials looking at systemic treatment options.

• #47 EANO guidelines for the diagnosis and treatment of ependymal tumors

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5909649/

  Ependymal tumors are rare CNS tumors and may occur at any age, but their proportion among primary brain tumors is highest in children and young adults. Thus, the level of evidence of diagnostic and therapeutic interventions is higher in the pediatric compared with the adult patient population. […] Surgery is the crucial initial treatment in both children and adults. In pediatric patients with intracranial ependymomas of WHO grades II or III, surgery is followed by local radiotherapy regardless of residual tumor volume. In adults, radiotherapy is employed in patients with anaplastic ependymoma WHO grade III, and in case of incomplete resection of WHO grade II ependymoma. […] A gross total resection is the mainstay of treatment in spinal ependymomas, and radiotherapy is reserved for incompletely resected tumors.

• #48 EANO guidelines for the diagnosis and treatment of ependymal tumors

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5909649/

  Recommendations regarding treatment of intracranial ependymomas in children are summarized in Tables 2, 3, and 4. […] Standard salvage options for recurrent ependymomas have not been identified. However, re-operation as well as re-irradiation are increasingly employed. […] The role of chemotherapy for treatment of recurrent ependymoma in adults remains unclear and is considered only when local treatment options (surgery and radiotherapy) have been exhausted. […] Recommendations regarding treatment of recurrent ependymomas are summarized in Table 3. […] Ependymal tumors of the spinal cord are more common in adults than in children. […] Advances in microsurgical techniques have allowed en bloc GTR over piecemeal subtotal resection (STR) as standard of care for spinal cord ependymomas. […] Recommendations regarding treatment of spinal cord ependymomas are summarized in Table 5.

• #49 Childhood Ependymoma Treatment (PDQ®): Treatment – Health Professional Information [NCI] – Health Information Library | PeaceHealth

  https://www.peacehealth.org/medical-topics/id/ncicdr0000062843

  The rationale for radiation therapy, as described in the Treatment of no residual disease, no disseminated disease section above, also pertains to the treatment of children with residual nondisseminated ependymoma. […] Patients with recurrent ependymomas should be considered for treatment with focal retreatment with various radiation modalities, including stereotactic radiosurgery, intensity-modulated photon therapy, and proton therapy. […] The utility of further surgical intervention is individualized, based on the extent and location of the tumor. A study of 53 patients with recurrent ependymoma demonstrated an improved 5-year overall survival rate of 48.7% for patients who had gross-total or near-total resections at the time of surgery, compared with 5.3% for patients with less than gross-total or near-total resections.

• #50 Childhood Ependymoma Treatment (PDQ®): Treatment – Health Professional Information [NCI] – Health Information Library | PeaceHealth

  https://www.peacehealth.org/medical-topics/id/ncicdr0000062843

  The rationale for radiation therapy, as described in the Treatment of no residual disease, no disseminated disease section above, also pertains to the treatment of children with residual nondisseminated ependymoma. […] Patients with recurrent ependymomas should be considered for treatment with focal retreatment with various radiation modalities, including stereotactic radiosurgery, intensity-modulated photon therapy, and proton therapy. […] The utility of further surgical intervention is individualized, based on the extent and location of the tumor. A study of 53 patients with recurrent ependymoma demonstrated an improved 5-year overall survival rate of 48.7% for patients who had gross-total or near-total resections at the time of surgery, compared with 5.3% for patients with less than gross-total or near-total resections.

• #51

  https://link.springer.com/article/10.1007/s11912-022-01260-w

  The benefit of postoperative radiotherapy for incompletely resected ependymomas in terms of local control and overall survival rates is clear. […] The toxicity of radiotherapy in younger children is of concern, and intensity-modulated radiation therapy is employed to limit late sequelae. Proton therapy could be an alternative to conventional photon radiotherapy for toxicity reduction. […] The role of chemotherapy in children remains unproven despite intensive investigation. […] Thus far, no targeted therapies are available in ependymomas. A recent preclinical study has suggested FGFR inhibition as a novel approach to target aggressive ependymomas. […] The extent of resection at recurrence appears important in improving the outcome. A recent study in children and adolescents has reported that gross- and near-total resection were achieved in 64% of patients and were associated with an improved 5-year survival (OS) of 48.7% vs 5.3% in less than gross total or near-total resection.

• #52 Ependymoma Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/277621-treatment

  Postoperative imaging is recommended to determine the extent of surgical resection. […] A team of specialists including a neurologist, neurosurgeon, neurooncologist, and radiation oncologist should evaluate patients with ependymomas to develop a coordinated treatment strategy. […] Long-term monitoring of ependymoma patients with periodic brain/spine MRI is recommended following gross total resection. Current NCCN recommendations specify tumor site MRI once every 3-4 months during the first year following resection, then every 4-6 months during the second year, and every 6-12 months for 5-10 years. […] Following recurrence, repeat resection is recommended if possible. Depending on the extent of this resection, either system or craniospinal radiation therapy is recommended.

• #53 Ependymoma Guidelines: Guidelines Summary

  https://emedicine.medscape.com/article/277621-guidelines

  The National Comprehensive Cancer Network (NCCN) recommends the following for treatment of adults with ependymoma: Following suspicion for ependymoma on neuroimaging, maximal safe resection should be performed. Following diagnosis of grade 2 or grade 3 ependymoma after resection/biopsy, conduct brain and spine MRI, plus LP to assess for leptomeningeal spread (LP contraindicated with posterior fossa masses). If post-resection neuroimaging is negative for metastasis, administer standard conformal radiation therapy (to tumor area plus 1-2cm margins). If metastasis detected, administer whole craniospinal radiation therapy (or proton therapy to reduce toxicity). Spinal ependymomas WHO Grade 2 do not require radiation therapy if gross total resection was performed and neuroimaging/LP are negative. MRI surveillance for recurrence following resection for 5-10 years. For recurrent ependymoma, patients who have not received radiation therapy should receive radiation therapy, and if a patient has received radiation therapy, then chemotherapy, radiation therapy, or supportive care should be considered.

• #54 EANO guidelines for the diagnosis and treatment of ependymal tumors

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5909649/

  Recommendations regarding treatment of intracranial ependymomas in children are summarized in Tables 2, 3, and 4. […] Standard salvage options for recurrent ependymomas have not been identified. However, re-operation as well as re-irradiation are increasingly employed. […] The role of chemotherapy for treatment of recurrent ependymoma in adults remains unclear and is considered only when local treatment options (surgery and radiotherapy) have been exhausted. […] Recommendations regarding treatment of recurrent ependymomas are summarized in Table 3. […] Ependymal tumors of the spinal cord are more common in adults than in children. […] Advances in microsurgical techniques have allowed en bloc GTR over piecemeal subtotal resection (STR) as standard of care for spinal cord ependymomas. […] Recommendations regarding treatment of spinal cord ependymomas are summarized in Table 5.

• #55 Ependymoma: Diagnosis and Treatment – NCI

  https://www.cancer.gov/rare-brain-spine-tumor/tumors/ependymoma

  The first treatment for an ependymoma is surgery, if possible. The goal of surgery is to obtain tissue to determine the tumor type and remove as much tumor as possible without causing more symptoms. […] Many people won’t need additional treatment after surgery. For those that do, these treatments may include radiation, chemotherapy or clinical trials. Clinical trials test new chemotherapy, targeted therapy, or immunotherapy drugs. Treatments are decided by the patient’s health care team based on the patient’s age, remaining tumor after surgery, tumor type, and tumor location.

• #56 Ependymoma – American Brain Tumor Association | Learn More

  https://www.abta.org/tumor_types/ependymoma/

  Ependymomas arise from the ependymal cells that line the ventricles of the brain and the center of the spinal cord. They are soft, grayish, or red tumors which may contain cysts or mineral calcifications. […] Common treatment options for ependymoma include surgery, radiation therapy, and in certain situations chemotherapy. However, different subtypes may be treated differently. Many patients won’t need additional treatment beyond surgery, depending on the tumor subtype and provided that the whole tumor is removed. For example, a subependymoma can be cured by surgery alone and does not typically recur if it is removed completely. If a patient with ependymoma needs more treatment after surgery, it would be either radiation therapy or chemotherapy. However, the role of chemotherapy remains unproven and is still being studied. For now, chemotherapy is often limited to the treatment of very young children and some adults with a recurrent tumor. […] The Collaborative Ependymoma Research Network (CERN) was developed to translate lab findings into clinical trials looking at systemic treatment options.

• #57 CAR T Cell Immunotherapy for Ependymoma Offers Expanded Clinical Trial Access | Alex’s Lemonade Stand Foundation for Childhood Cancer

  https://www.alexslemonade.org/blog/car-t-cell-immunotherapy-ependymoma-offers-expanded-clinical-trial-access

  Leevi was diagnosed at age 2 with ependymoma and relapsed at age 5. After frontline treatment failed, Leevi enrolled in a clinical trial. […] Using Alex’s Lemonade Stand Foundation (ALSF) Center of Excellence (COE) grant funding, Dr. Hegde is leading a Phase 1 study of CAR T cells for patients with refractory or relapsed ependymoma. The study, which opened in early 2022 at three childrens hospitals, will give patients access to treatment closer to home. Local approval is also underway at three more hospitals. […] Ependymoma, the third most common type of pediatric brain tumor, is notoriously unresponsive to standard chemotherapies. For the approximately 200 children diagnosed each year, the best treatment option is surgical removal followed by radiation therapy. […] Access to safer treatment and cures is desperately needed for kids facing hard-to-treat cancers like ependymoma.

• #58 CAR T Cell Immunotherapy for Ependymoma Offers Expanded Clinical Trial Access | Alex’s Lemonade Stand Foundation for Childhood Cancer

  https://www.alexslemonade.org/blog/car-t-cell-immunotherapy-ependymoma-offers-expanded-clinical-trial-access

  Not only do multisite clinical trials allow more patients to access potentially lifesaving treatment while supporting a higher quality of life, but they can also increase the pace of discovery by increasing trial enrollments. […] Texas Childrens Hospital is one of ALSFs Center of Excellence grant-funded institutions. ALSF provides COEs with support to build clinical trial infrastructure. […] For the treatment of ependymoma and other malignant brain tumors, research into CAR T immunotherapy is still in the early phases. […] The hope is that this trial offers more insights into the potential of CAR T immunotherapy for kids with ependymoma, opening the door to more studies that can help kids with other malignant brain tumors.

• #59 Ependymoma Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/277621-treatment

  The extent of tumor resection is the most important prognostic factor associated with long-term survival for patients with nonmalignant forms of ependymoma, regardless of location. Thus, a gross total resection (GTR) is optimal. The feasibility and extent of the resection will vary with the location of the tumor and the clinical characteristics of the patient. […] Resection is typically followed by histologic analysis and molecular testing to classify the tumor and guide prognostic estimates. Depending on the type of tumor, adjuvant treatment with radiation may be indicated. Currently, there are no ependymoma-specific molecular therapies, but this is an area of active research. […] Due to the risk of ependymoma recurrence, MRI surveillance typically follows treatment. […] Though surgical treatment is the primary treatment for ependymoma, medical management also plays a role. General medical management may include steroids for treatment of peritumoral edema and anticonvulsants. In the case of incomplete tumor resection or recurrence, radiation is central to medical management.

• #60 Ependymoma Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/277621-treatment

  Postoperative imaging is recommended to determine the extent of surgical resection. […] A team of specialists including a neurologist, neurosurgeon, neurooncologist, and radiation oncologist should evaluate patients with ependymomas to develop a coordinated treatment strategy. […] Long-term monitoring of ependymoma patients with periodic brain/spine MRI is recommended following gross total resection. Current NCCN recommendations specify tumor site MRI once every 3-4 months during the first year following resection, then every 4-6 months during the second year, and every 6-12 months for 5-10 years. […] Following recurrence, repeat resection is recommended if possible. Depending on the extent of this resection, either system or craniospinal radiation therapy is recommended.

• #61 Ependymoma | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/e/ependymoma.html

  You and your medical team will decide on the best treatment plan for you. Treatment depends on the type of tumor and where it is. Your healthcare team will help you decide the best treatment plan for you. The main treatment in adults is surgery to remove as much of the tumor as possible. Your chances of the best outcome are highest if the tumor can be fully removed. […] Radiation therapy might be used after surgery. If the tumor has spread, which is rare, chemotherapy may be needed after surgery. It can be given as a pill or put right into a vein by IV (intravenous) line into your blood. A needle can be used to put chemo into your CSF (spinal fluid), too. (This is called intrathecal chemo.) […] Most people with an ependymoma respond well to treatment and have a good outcome. Sometimes higher grade ependymomas come back after treatment. To check for this, you’ll likely need to have follow-up MRI scans in the weeks after surgery, and then a few times a year after that.

• #62 What is Ependymoma: Symptoms, Causes, & Treatment

  https://www.webmd.com/cancer/brain-cancer/what-is-ependymoma

  You or your child may have long-lasting side effects related to treatment for the tumor. It can take weeks or months for them to show up. Problems may be physical, like headaches and fatigue, or emotional, like depression. […] The 5-year survival rate is high for people treated for ependymoma. The rate is slightly lower for children under age 19. […] It’s not unusual for an ependymoma to grow back after treatment, especially in children. If it does come back, it’s usually in the same spot as the original tumor.

• #63 Ependymoma > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/ependymoma

  About 79% of people diagnosed with ependymoma live for 5 years or longer. Patients tend to have better outcomes when doctors are able to remove all or most of the tumor surgically. […] Yales Pediatric Neuro-Oncology program is a multidisciplinary collaboration between pediatric neuro-oncologists, neurologists, neurosurgeons, neuro-radiologists, and neuro-pathologists specifically trained in the treatment of children with brain tumors.

• #64 Childhood Ependymoma | Dana-Farber Cancer Institute

  https://www.dana-farber.org/cancer-care/types/childhood-ependymoma

  Radiation therapy: This treatment uses high-energy waves from a specialized machine to damage or shrink tumors. […] Chemotherapy is a drug treatment that interferes with a cancer cell’s ability to grow or reproduce. […] Ependymoma treatments can depend on the site of the tumor and whether it is recurrent (doesn’t resolve after initial treatment) or not. […] Within the brain and posterior fossa, outcomes are best when a combination of complete surgical removal and high dose focal radiation therapy is possible. […] Follow-up cancer care is critical to your child’s physical, mental, and emotional health. Beyond initial treatment, we continue to care for the physical, mental, and emotional health needs of children through our extensive pediatric cancer survivorship programs. […] The cure rate for ependymoma with complete surgical removal is 65 percent. […] Metastatic, progressive, or recurrent ependymomas are most challenging to cure.

• #65 What is Ependymoma: Symptoms, Causes, & Treatment

  https://www.webmd.com/cancer/brain-cancer/what-is-ependymoma

  You or your child may have long-lasting side effects related to treatment for the tumor. It can take weeks or months for them to show up. Problems may be physical, like headaches and fatigue, or emotional, like depression. […] The 5-year survival rate is high for people treated for ependymoma. The rate is slightly lower for children under age 19. […] It’s not unusual for an ependymoma to grow back after treatment, especially in children. If it does come back, it’s usually in the same spot as the original tumor.

• #66 I am a Grade 3 Anaplastic Ependymoma Survivor: Survivorship Story — Cancer Survivors Network

  https://csn.cancer.org/discussion/325868/i-am-a-grade-3-anaplastic-ependymoma-survivor-survivorship-story

  In 2016 I turned 18 years old. Three weeks later I was diagnosed with a Grade 3 Anaplastic Ependymoma. […] The treatment plan was surgery, chemotherapy, (proton) radiation therapy. […] The removal of the tumor would reduce the odds of tumor regrowth to 30%. The additional chemotherapy and radiation would further reduce the likelihood for regrowth to 20%. […] I began chemotherapy following my discharge from the hospital. I am fortunate to have only undergone two rounds of chemotherapy. […] I underwent chemotherapy treatment for 2 months. Shortly afterwards, I began proton radiation therapy. […] This treatment was intense; I received treatment 5 days a week for 6 weeks. […] The treatment plan included a 3rd round of chemotherapy, one my family and I ultimately decided not to undergo. […] The highest rate of regrowth for Grade 3 Anaplastic Ependymomas occurs in the first 2 years. […] The next goal became hitting the 5 year mark. […] The next milestone is to reach „10 years cancer free”.

• #67 Living With Ependymoma | Expert Surgeon | Aaron Cohen-Gadol, MD | Aaron Cohen-Gadol, MD

  https://www.aaroncohen-gadol.com/en/patients/ependymoma/survival/living-with-ependymoma

  According to a study performed at the M.D. Anderson Cancer Center, adult patients with anaplastic ependymoma lived for about 5 to 6 years after diagnosis. Another study at the Preston Robert Tisch Brain Tumor Center at Duke found that approximately 40% of patients with Grade 3 ependymomas survived at least 10 years.

• #68 Ependymoma – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538244/

  The extent of surgical resection for intracranial ependymomas has been the most reliable and consistent independent prognostic factor. […] Patients who undergo complete resection without signs of residual disease have presented a better outcome and overall survival compared to patients who undergo partial resection. For this reason, treatment typically consists of aggressive surgical excision. […] Across the different subgroups, infratentorial ependymomas generally have an excellent prognosis, even without treatment. Supratentorial ependymomas, however, often present a higher histological grade and have a lower survival rate despite treatment with resection and adjuvant radiation. […] The mainstay of treatment for ependymoma includes an interprofessional approach that may include surgery, radiation therapy, and chemotherapy.

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