Ependymoma Health Article

Clinical staging, treatments, and prognosis

There is no formal staging system for ependymomas. They are divided into supratentorial and infratentorial tumors and treated accordingly. Treatment will proceed depending on a number of factors such as the patient's general health and age, the size and location of the ependymoma, and whether it has spread. Before any treatment is given for ependymoma, it will be important to reduce the pressure in the skull if this has occurred. If it is due to a buildup of CSF, a shunt may be inserted to drain off the excess fluid. Steroid drugs may also be prescribed to reduce swelling around the ependymoma.

When possible, surgery is the first form of treatment for ependymoma. The purpose of surgery is to remove as much of the tumor as possible without damaging the healthy brain tissue. However, it may not be possible to remove it entirely and follow-up treatment may be required. One approach is to prescribe repeated surgery in patients who still have ependymoma remaining after a first surgery and radiation therapy.

Radiation therapy, or the use of high-energy rays to destroy the cancer cells, is often used after surgery to destroy any remaining cancer cells. It may also be used alone to treat ependymomas that cannot be reached by surgery. Since ependymomas may spread to the spinal cord, radiation therapy is sometimes given to both the brain and spinal cord. Radiation oncologists are also using focal radiation techniques, meaning that they give a single large dose of radiation so as to kill residual cancer cells after regular radiation therapy in patients who have significant tumor tissue remaining after surgery.

Chemotherapy, or the use of anti-cancer drugs to destroy cancer cells, is another form of treatment indicated for ependymomas. It may be given alone or in conjunction with surgery and radiation therapy. Newer and improved chemotherapeutic drugs are now being used after surgery, with the goal of shrinking the ependymoma before radiation therapy.

Postoperative radiation therapy has definitely been shown to improve chances of recovery, but results of chemotherapy are considered somewhat disappointing. Age is also a factor in recovery. Usually, the younger the patient, the less favorable the prognosis. The best recoveries usually occur in patients who have no visible tumor after surgery.

Alternative and complementary therapies

In a search for less toxic therapies and improved quality of life, patients with primary brain tumors are increasingly considering complementary and alternative treatments. The American Brain Tumor Association provides a list of therapies such as acupuncture, antioxidant therapy, acupressure, meditation, etc. However, the association does not officially endorse any of them. The treatment team will be able to offer the best advice as to whether alternative and/or complementary treatments are indicated.

Coping with cancer treatment

Learning to live with ependymoma can be difficult for both patient and family. Several national associations exist to educate, support and advocate for families of children with cancer, survivors of childhood cancer, and the health professionals who care for them. These organizations offer contacts with peer-support groups and distribute a wealth of cancer-related brochures and publications.

Clinical trials

In 2001, the National Cancer Institute supported over 33 ependymoma clinical trials to evaluate a variety of new treatments. The National Cancer Institute monitors clinical trials and should be contacted for up-to-date information.

Prevention

A large, coordinated investigation recently carried out in Europe, Israel, and North America studied the factors that might affect the occurrence of primary brain tumors in infants and children under the age of 20. Conclusions were that women taking vitamin supplements containing C, A, E, and/or folate during the entire period of their pregnancy were half as likely to have their child develop a brain tumor before age 5, as compared to those who did not take vitamins.