Guidelines for the treatment of adult intra-cranial grade II-III ependymal tumours.

Intra-cranial ependymal tumours are very rare in the adult population, so most of reported series are retrospective, include also paediatric patients and have limited statistical power due to the small number of cases. As a consequence, universally accepted prognostic factors and therapeutic guidelines are lacking. The addition of postoperative chemotherapy with lomustine, vincristine and prednisone to cranio-spinal irradiation did not improve survival with respect to RT alone in a randomised phase III trial of children with infratentorial ependymoma. Different chemotherapy regimens have been tested in children with ependymoma or anaplastic ependymoma yielding comparable results to those reported for patients receiving RT alone. No data is available for adult population. Thus far, there is no proof that the addition of chemotherapy to RT improves the outcome and adjuvant chemotherapy should be confined to investigational controlled clinical trials.