Surgery

Surgery for these tumours is rarely curative in and of itself, but is generally the first means taken towards treatment.

Complete surgical resection can be difficult. This is particularly true of posterior fossa ependymomas, as they are attached to the floor of the fourth ventricle, and for tumours that involve the brainstem. Supratentorial tumours and those on the roof of the fourth ventricle are more inclined to complete resection. Regardless of these risks, gross total resection continues to be associated with increased survival rates, and the extent of resection is still considered a good prognostic factor.

Chemotherapy

Chemotherapy treatments for ependymomas are highly variable, and there is not yet a standard protocol employed for these tumours. Chemotherapy treatments are of more use in children than in adults. The most common reasons for the use of chemotherapy are to delay radiation post-operatively and treat recurrent tumours after maximum radiation has been given. Overall, the efficacy of chemotherapy in treating ependymomas is modest, and it does not provide the same degree of postoperative benefit as radiation therapy. The benefit of adjuvant chemotherapy remains unclear. There is a current COG trial (ACNS 0121) looking at chemotherapy after subtotal resection using Vincristine, Carboplatin, and cyclophosphamide alternating with Vincristine, Etoposide, and Cisplatin. Multiple retrospective reviews have evaluated the role of pre-operative chemotherapy in newly diagnosed ependymoma and none have been found to improve survival.

Studies comparing radiation versus radiation with chemotherapy showed no improvement with addition of chemotherapy.