Treatment for Adults

Cancer treatment for adults may include one or a combination of the following:

Surgery

When possible, removing the brain or spinal cord tumor is the first step in treatment. 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. Surgery is performed by a neurosurgeon and involves entering the skull, neck or spine to remove the tumor. Read more about neurosurgery.

Radiation Treatment

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 treatments are given daily as an outpatient over several weeks.

There are several methods of delivering radiation treatment.  Conformal radiotherapy and intensity-modulated radiotherapy (IMRT) are computer assisted techniques that are more precise. Proton beam radiotherapy is another technique used. It may provide additional protection of the normal structures compared to other X-ray techniques.

Stereotactic radiosurgery (SRS) is another technique for delivering radiation therapy. SRS allows precisely focused, high-dose X-ray beams to be delivered to a small, localized area of the brain.  It is administered over 1-3 days. It requires very precise planning and treatment delivery. It can be delivered with a variety of different machines including: linear accelerator, Gamma Knife® or Cyberknife®. Read more about specific radiation options.

Chemotherapy

Chemotherapy is drug treatment for cancers or tumors. There are many types of drugs used to treat cancer. Traditional chemotherapy are called cytotoxic agents designed to kill growing tumor cells.  These agents often have side effects such as hair loss, nausea and vomiting and can cause a decrease in blood counts. However, now there are more types of drugs available. These include drugs called signal pathway modulators. These drugs target molecular pathways in cancer cells that cause the cell or pathway to survive. These drugs can either be chemical agents or antibodies targeting proteins in the pathways. Examples are drugs that impact formation of blood vessels in the tumor or that allow invasion of the tumor into surrounding normal tissue. These drugs typically have different side effects. For example, some cause skin rash, others cause diarrhea. Usually these drugs do not cause low blood counts or hair loss.

The Current Standard of Care for Ependymomas

One of the great challenges in knowing what treatment is best is the rarity of the disease. Most doctors see fewer than a handful of patients with ependymoma each year. A primary goal of the CERN Foundation is to establish a network of centers for patients with ependymoma. The CERN Foundation is designed to be a referral source so that patients can find the best treatments available.

Grade I or II

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.

Complete surgical removal is often not possible because of the location of the tumor and the concern for damage to surrounding brain or spine tissue during the operation.  Radiation treatment is often recommended for patients where the ependymoma could not be completely removed.  Additionally, there are conflicting opinions whether all patients with low-grade ependymoma should receive radiation to the area of tumor regardless of the extent of tumor removal.

Grade III

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.  If there is tumor spread into other parts of the central nervous system or spinal fluid, the brain and spinal cord may need radiation treatment.  Chemotherapy may be given in addition to radiation. Since this is rare, there are only a limited number of studies evaluating chemotherapy treatment on anaplastic ependymoma tumors. And none have specifically tested whether adding chemotherapy improves outcomes. Talk to your doctor.

Alternative and Complementary Therapies

The CERN Foundation is not currently investigating the effects of alternative and complementary therapies on ependymoma. However, some patients research these options with the guidance of their doctors. Some options include massage or diet.

Your Medical Team

There are several members of your medical team that may be involved in your care.

Members of this neuro-oncology team typically include:

  • Neuro-oncologist – a doctor who treats brain or spine cancer
  • Neurologist – a doctor who deals with disorders of the nervous system
  • Neurosurgeon – a doctor who operates on the brain or spine
  • Radiation oncologist – a doctor who administers radiation therapy
  • Neuropathologist – a doctor who studies diseases of the nervous system
  • Neuro-ophthalmologist – a doctor who deals with diseases that manifest in the visual system
  • Psychologists and social workers – offer emotional support and assists in managing the practical and financial impact of a tumor
  • Nurses and nurse practitioners – oversee the management of patient care as recommended by doctor

If you or your medical team has a specific question on the treatment options for ependymoma, please contact us.

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