Chemotherapy to Spare Cognition

In this 13-month-old girl with anaplastic ependymoma, biopsy of the suspicious mass is strongly recommended because treatment varies significantly if the disease has metastasized.1 If this mass is benign, we recommend radiation to the primary tumor bed with 5 mm clinical target volume and 3 mm planning target volume margins using proton therapy to a total dose of 54 Gy (relative biological effectiveness) (Fig. 1). If the spinal disease is biopsy-proven metastatic ependymoma, there are several options, though none ideal.

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