Do you recommend adjuvant radiotherapy for an adult patient with localized myxopapillary ependymoma, WHO Grade 2, status-post gross total resection?

I assumed that this is a case of spinal ependymoma. Myxopapillary ependymomas are rare tumors and optimal therapeutic strategy involves a Gross Total Resection (GTR). The more complete the surgery the better the outcome. The role of postoperative radiation after a GTR is somewhat controversial but I prefer treating patients (especially adults) with adjuvant post-operative RT with a dose of 50.4 - 54 Gy to reduce the risk of local recurrence. In a retrospective study from Switzerland (Pica et al., PMID 19250760), the PFS was 74.8% with post-op RT versus 50.4% without. I treat generously targeting 3-4 cm above the location of the primary, to include the entire thecal sac caudally as there is the potential of drop metastases following surgery....

Before the 2021 WHO Classification of CNS Tumors was released, spinal myxopapillary ependymoma (MPE) was classified as grade 1 as it was commonly recognized as a slow-growing and fairly indolent neoplasm. However, in 2021, it was reclassified as grade 2. This change was prompted by an evolving understanding of the tumor's increased risk of recurrence, both locally and in distant areas. The choice of treatment following a gross total resection (GTR) of the tumor is not well-defined and depends on various factors, including (but not limited to) the patient's age, other life-limiting comorbidities, goals of care, ability to adhere to follow-up care, and surgeon's intraoperative comments (i.e. surgeon's assessment of the extent of the tumor rem...