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Reirradiation for Patients With Recurrent Ependymoma Across the Age Spectrum
Ying Ying Sum1,2, Julie Bennett2,3, Vijay Ramaswamy2
1Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
Advances in Radiation Oncology
|May 25, 2026
Summary
Repeat radiation therapy (RT2) with craniospinal irradiation (CSI) significantly improves overall survival (OS) in patients with recurrent ependymoma. Gross total resection of recurrent disease also improves outcomes, highlighting surgical and radiation strategies for better disease control.
Area of Science:
- Neuro-oncology
- Radiation Oncology
- Pediatric Oncology
Background:
- Ependymoma recurrence poses a significant challenge in neuro-oncology.
- Previous studies suggest craniospinal irradiation (CSI) as part of repeat radiation therapy (RT2) may improve outcomes over focal RT2 alone for recurrent ependymoma.
Purpose of the Study:
- To report long-term outcomes of adults and children with recurrent intracranial ependymoma treated with repeat radiation therapy (RT2).
- To evaluate the impact of craniospinal irradiation (CSI) as part of RT2 on overall survival (OS).
Main Methods:
- Retrospective, single-institution study of 48 patients treated with RT2 for recurrent ependymoma (1999-2024).
- Primary endpoint: overall survival (OS) from start of RT2.
- Kaplan-Meier method for OS estimation; log-rank test for group comparisons.
Main Results:
- Gross total resection prior to RT2 was associated with significantly better 5-year OS (57% vs 19%, P=.015).
- For patients with local recurrence, CSI-RT2 demonstrated significantly higher 5-year OS (78%) compared to focal RT2 (36%, P=.040).
- Patients with disseminated disease had a 5-year OS of 20%.
Conclusions:
- Gross total resection of recurrent ependymoma is linked to improved survival.
- Craniospinal irradiation (CSI) as part of repeat radiation therapy (RT2) is associated with longer overall survival in locally recurrent ependymoma patients.
- Further research is needed to elucidate the independent effects of CSI-RT2 and extent of re-resection.
