Should post-op RT be delayed for children < 3yo after a GTR resection for a posterior fossa or supratentorial ependymoma?

Standard of care for a GTR posterior fossa ependymoma of any histologic grade is immediate adjuvant radiotherapy. If a STR is encountered, chemotherapy may be considered to try and facilitate a second look surgery. The current protocol allows patients with supratentorial ependymomas that have received a GTR to be observed as long as they are of classic histology.

There may be subpopulations of pediatric brain tumors where observation following GTR may be more tractable and unlikely to impact survival. The implications of radiotherapy at an early age for young children are substantial and efforts to avoid RT may be preferred. Over the last several years, we have learned that there are variably behaving molecular subtypes of tumors which may b...