What is your approach to management of a myxopapillary ependymoma of the conus with drop metastases to the cauda equina?

Usually I treat with localized fields but feel there is no correct answer. I offer the patients CSI as an alternative and explain benefits and risks.

These patients are expected to live very long lives and 36 Gy CSI will have tremendous adversely affect on them. I acknowledge the risk of re-irradiat...