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How would you approach adjuvant radiation therapy for a young adult woman with recurrent myxopapillary ependymoma?

She initially underwent complete resection of a WHO grade 2 myxopapillary ependymoma 3 years ago without adjuvant radiation. One year ago, she developed an isolated recurrence in the left inguinal lymph nodes, which was treated with resection alone; the diagnosis was confirmed on pathology review at a tertiary center. Staging imaging at that time showed no other sites of disease. She now presents with a second isolated recurrence in the precoccygeal region, status post complete resection. Repeat staging imaging again demonstrates no other evidence of disease. Molecular testing has not identified an actionable driver mutation. Given this pattern of recurrent, apparently oligometastatic disease, what radiation volume and dose would you recommend? Would you treat the postoperative precoccygeal bed alone, include the previously involved inguinal nodal basin, or consider a broader elective volume?
1 Answer
Mednet Member
Mednet MemberInvited Expert
Radiation Oncology · University of Arizona
Answered on

Extraneural spread of a myxopapillary ependymoma is exceptionally rare. In this case, I would strongly favor adjuvant local radiotherapy to the postoperative sites, assuming they have not previously received prohibitive radiation doses (especially the pre-coccygeal site).

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