Adult WHO Grade II/III Intracranial Ependymoma: Postoperative Management When Surgical Resection Did Not Achieve Gross Total Removal

Patient Population

Adults ≥ 18 years

This protocol applies to adults (age 18 years or older) with newly diagnosed intracranial ependymoma of WHO grade II or WHO grade III. It addresses postoperative management in the specific setting where surgical resection was not complete.

Prior Treatment & Escalation Trigger

The preceding step was surgical resection — performed to obtain a histological diagnosis with the aim of gross total resection, including consideration of second-look surgery when the initial result was unsatisfactory.

Goal not met, prompting this step: Gross total resection with no residual disease on postcontrast T1- and T2-weighted images on the 3-month postoperative MRI.

Postoperative Treatment Approach

In adults with WHO grade II or grade III intracranial ependymoma, the postoperative approach centres on conformal radiotherapy — the specific configuration informed by tumour grade, extent of resection, and dissemination status. The complete structured protocol is available below.

Instant Access to Structured Evidence-Based Regimens

References

Key recommendations for the treatment of newly diagnosed intracranial WHO grades II and III ependymomas in adults.

In adults, radiotherapy is employed in patients with anaplastic ependymoma WHO grade III, and in case of incomplete resection of WHO grade II ependymoma.

Postoperative conformal radiotherapy with doses up to 60 Gy is recommended for patients with WHO grade III (anaplastic) ependymomas regardless of the extent of resection.

Postoperative conformal radiotherapy with doses of 54–59.4 Gy is recommended for patients with WHO grade II ependymomas following incomplete resection.

Craniospinal irradiation (CSI) of 36 Gy is recommended in case of CSF or spinal dissemination with a boost up to 45–54 Gy on focal lesions.

DOI: 10.1093/neuonc/nox166

View source ↗