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Ependymoma Adjuvant — SCE Medical Oncology MCQ

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ModerateCNS TumoursEpendymoma AdjuvantSCE Medical Oncology

A 62-year-old man with a WHO grade 2 ependymoma of the posterior fossa undergoes complete surgical resection. Post-operative MRI confirms no residual disease. What adjuvant treatment is standard?

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Correct answer: C — For completely resected intracranial WHO grade 2 ependymoma with no residual disease, observation with MRI surveillance is a reasonable approach — adjuvant RT is generally reserved for incomplete resection, grade 3 (anaplastic) histology or recurrence

Explanation lettering: C = shown as A · E = shown as B · B = shown as C · A = shown as E

Intracranial ependymoma management is primarily surgical. For completely resected WHO grade 2 ependymomas, the role of adjuvant RT is debated: some centres offer focal RT (54 Gy) to reduce local recurrence, while others observe with MRI surveillance and reserve RT for recurrence. Adjuvant RT is more strongly recommended for: incomplete resection, grade 3 (anaplastic) histology, or infratentorial location (higher recurrence risk). Chemotherapy has limited efficacy in ependymoma. Molecular classification (RELA fusion, posterior fossa group A/B) is increasingly guiding management.

Reference: NICE NG99; ESMO 2024 CNS; Merchant et al JCO 2019