Retrospective analysis of long-term outcomes and late effects of surgery and radiotherapy for intracranial ependymoma

A retrospective analysis evaluated the long-term outcomes of surgery alone or surgery plus radiotherapy for adult patients with WHO grade 2-3 intracranial ependymoma at Mass General Brigham Cancer Institute (Boston, MA) between 2000 and 2024. Fifty-eight patients met the inclusion criteria. Median age was 39 years (IQR 25-51), median follow-up was 51 months (IQR 23-103), 76% WHO grade 2, 74% posterior fossa location, 60% gross total resection, 88% adjuvant local radiotherapy, 5% adjuvant chemotherapy). Five- and 10-year progression-free survival rates were 80% and 64%, respectively; 5- and 10-year overall survival rates were 92% and 85%, respectively. There were 13 (22%) recurrences; location of first failure was local in nine, distant in two, and both local and distant in two. Five- and 10-year local control rate was 82% (95% CI 67-90) and 72% (53-84). The median time to local failure was 5.4 years. Ten patients (22%) experienced at least one grade ≥ 2 late treatment-related toxicity. One potential secondary glioma (grade 5) occurred after nine years. The authors conclude that surgery alone or surgery followed by radiotherapy resulted in relatively favorable long-term outcomes in adult patients with intracranial ependymomas.