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Clin Transl Oncol. 2019 Mar 13. doi: 10.1007/s12094-019-02082-2. [Epub ahead of print]

Central nervous system ependymoma: clinical implications of the new molecular classification, treatment guidelines and controversial issues.

Author information

1
Servicio de Neurocirugía, Hospital Universitario de Burgos, Avda Islas Baleares 3, 09006, Burgos, Spain. pedrodl@yahoo.com.
2
Servicio de Oncología Radioterápica, Hospital Universitario de Burgos, Burgos, Spain.
3
Servicio de Radiología, Hospital Universitario de Burgos, Burgos, Spain.
4
Servicio de Neurocirugía, Hospital General Universitario "Gregorio Marañón" de Madrid, Madrid, Spain.
5
Servicio de Neurofisiología Clínica, Hospital Universitario de Burgos, Burgos, Spain.
6
Servicio de Neurocirugía, Hospital Universitario de Burgos, Avda Islas Baleares 3, 09006, Burgos, Spain.

Abstract

Ependymoma is an uncommon neuroepithelial tumor that may arise anywhere within the neuroaxis, both in children and in adults. It has been classically graded upon histopathological features, yet with limited clinical utility. Recently, DNA methylation profiling has provided a novel classification of ependymoma in nine molecular subgroups. This stratification method harbors prognostic value with supratentorial RELA-fusion and posterior fossa group A tumors showing a significantly shorter survival compared to the rest. Currently, the treatment of choice involves maximal safe resection and, in cases of residual disease, adjuvant conformal radiotherapy. Second-look surgery is also a feasible and recommended option for incompletely resected tumors. The role of chemotherapy is not yet established and can be considered in infants and children with relapsing disease or prior to re-intervention. Although targeted agents do not seem to play a role as adjuvant therapy, they are currently being tested for recurrent disease.

KEYWORDS:

Chemotherapy; DNA profile; Ependymoma; Prognosis; Radiotherapy; Resection

PMID:
30868390
DOI:
10.1007/s12094-019-02082-2

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