Receiving a diagnosis of ependymoma is a life-altering event for patients and their families. This rare type of tumor, which forms in the brain or spinal cord, can cause a range of symptoms depending on its location, including headaches, balance issues, seizures, or back pain. Because these tumors often affect children, the diagnosis can feel particularly overwhelming. However, understanding the treatment landscape provides a roadmap for management. 

Treatment is critical to remove the tumor, relieve pressure on the nervous system, and prevent the cancer cells from spreading via the cerebrospinal fluid. While the journey is complex, multidisciplinary teams work together to preserve neurological function and quality of life. Because ependymomas vary by “grade” (how aggressive they are) and location, treatment plans are highly personalized. Decisions are based on the patient’s age, the extent of surgical removal possible, and the specific molecular characteristics of the tumor (National Cancer Institute, 2023). 

Overview of treatment options for Ependymoma 

The standard of care for ependymoma typically begins with surgery. The primary goal is “maximal safe resection” removing as much of the tumor as possible without damaging vital brain or spinal tissue. Following surgery, radiation therapy is almost always used to kill remaining microscopic cells and prevent regrowth. 

However, medications play a distinct and supportive role in this treatment paradigm. While chemotherapy is generally less effective against ependymoma compared to other brain tumors, it is utilized in specific scenarios. Medications are primarily used when the patient is too young for radiation (typically infants), when the tumor cannot be fully removed surgically, or if the tumor returns (recurrence). Additionally, supportive medications are essential for managing the symptoms caused by the tumor’s pressure on the brain. 

Medications used for Ependymoma 

When chemotherapy is indicated, doctors typically use a combination of drugs rather than a single agent. This is often part of a clinical trial or a specialized protocol for recurrent cases. 

Platinum-based chemotherapy agents, such as cisplatin or carboplatin, are frequently used. These are often combined with other drugs like vincristine or etoposide. Clinical experience suggests that while these drugs may not cure the tumor on their own, they can help shrink it or delay its growth, which is particularly vital in delaying radiation for very young children to protect their developing brains. 

For patients with recurrent ependymoma, doctors may consider alkylating agents like temozolomide, an oral chemotherapy drug often used in other brain cancers. Additionally, targeted therapies such as bevacizumab may be employed. Bevacizumab is not a chemotherapy drug but a monoclonal antibody used to starve the tumor of its blood supply. 

Supportive medications are also a key part of the daily regimen. Corticosteroids, such as dexamethasone, are standard first-line drugs used to reduce brain swelling (edema) caused by the tumor or surgery. If seizures are a symptom, anticonvulsants (anti-seizure medications) like levetiracetam are prescribed to stabilize electrical activity in the brain (American Society of Clinical Oncology, 2023). 

How these medications work 

Chemotherapy drugs like cisplatin and carboplatin work by disrupting the DNA inside the cancer cells. By damaging the genetic blueprint the cells need to replicate, these drugs stop the tumor cells from dividing and growing. 

Bevacizumab works differently by inhibiting “angiogenesis.” Tumors need a robust blood supply to grow; this medication blocks a protein called VEGF, effectively cutting off the new blood vessels that feed the tumor. 

Corticosteroids act as powerful anti-inflammatories. They reduce the leakage of fluid from blood vessels in the brain, which lowers intracranial pressure. This provides relief from headaches and neurological deficits, improving the patient’s comfort and safety before and after other treatments. 

Side effects and safety considerations 

Chemotherapy, by targeting rapidly dividing cells, commonly causes fatigue, nausea, hair loss, and increased infection risk from low blood counts. Platinum-based drugs specifically risk hearing loss (ototoxicity) and kidney strain, requiring regular monitoring.  

Bevacizumab may impair wound healing and elevate blood pressure. Long-term corticosteroid use can lead to fluid retention, increased appetite, sleep issues, and mood swings. Promptly report signs of infection, like fever, especially during chemotherapy. Seek immediate medical attention for a seizure, severe headache, or sudden change in alertness (Mayo Clinic, 2022). 

Since everyone’s experience with the condition and its treatments can vary, working closely with a qualified healthcare provider helps ensure safe and effective care. 

References 

1. National Cancer Institute. https://www.cancer.gov 

2. American Society of Clinical Oncology. https://www.cancer.net 

3. Mayo Clinic. https://www.mayoclinic.org 

4. National Brain Tumor Society. https://braintumor.org