Received: 11 October 1999 Abstract The objective of this ret- rospective study was to evaluate the relative effect of surgery and radio- therapy (RT) on the survival of 25 consecutive children and young adults treated for ependymoma [18 in the posterior fossa (PF), 2 in supra- tentorial locations (ST) and 5 in in- traspinal locations (IS)]. Five-year survival rates for patients with PF, ST and IS tumors were 28%, 0% and 100%, respectively. Total tumor re- section was a positive prognostic factor in the case of PF tumors. No patients with subtotal removal of a PF tumor survived for longer than 5 years. The effect of RT on survival of patients with PF ependymomas in this series was uncertain. No patients with PF ependymoma had dissemi- nated disease at diagnosis, and all tu- mor recurrences were local. Based on these observations, we see no in- dications for craniospinal RT of PF ependymomas, except in rare cases of disseminated disease. If RT is giv- en, it should only be targeted to the tumor site. The two patients with ST ependymoma died within 3.8 years after primary treatment. Our series of ST ependymomas does not allow any specific treatment recommenda- tions. One patient with IS ependy- moma was cured by surgery alone. Four patients with IS ependymoma had documented residual tumor after surgery. RT induced remission in these patients. For IS ependymomas we recommend no RT if total tumor removal can be documented. In pa- tients with subtotal removal of IS ependymomas local RT is effective and should be given. Keywords Brain neoplasm · Ependymoma · Survival · Surgery · Radiotherapy Child’s Nerv Syst (2001) 17:24–30 © Springer-Verlag 2001 ORIGINAL PAPER Eirik Helseth Bernt Due-Tønnessen Knut Lote Kari Skullerud Ingebjørg Storm-Mathisen Finn Wesenberg Tryggve Lundar Ependymoma in children and young adults (0–19 years): report of 25 consecutive cases Introduction Ependymoma is a central nervous system tumor that arises from the ependymal cells lining the cerebral ven- tricles and central canal of the spinal cord. Spinal epen- dymomas have a better prognosis than intracranial epen- dymomas, and the beneficial effect of radiotherapy (RT) on survival of patients with spinal ependymomas is doc- umented [17, 26, 31, 33]. The effect of RT on survival in the case of intracranial ependymomas is still controver- sial. It is known, however, that cranial radiation of chil- dren may cause serious late sequelae, which are rarely seen in children treated with surgery alone [3, 4, 10, 27, 29]. Some children with intracranial ependymoma are cured by total surgical resection alone [11, 16]. It is therefore extremely important to establish whether or not postoperative RT increases survival in this subgroup of patients. If no effect can be documented, postoperative RT should not be given. The objective of this study was to evaluate the relative effects of surgery and RT on sur- vival in 25 consecutive children and young adults treated for ependymoma in our departments from 1970 to 1998. E. Helseth ( ✉ ) · B. Due-Tønnessen T. Lundar Department of Neurosurgery, The National Hospital, 0027 Oslo, Norway e-mail: eirik.helseth@rikshospitalet.no Tel.: +47-23074342 K. Lote Department of Oncology, The Norwegian Radium Hospital, Oslo, Norway K. Skullerud Department of Pathology, The National Hospital, Oslo, Norway I. Storm-Mathisen · F. Wesenberg Department of Pediatrics, The National Hospital, Oslo, Norway