Table 1.
Open in new tab

Overview of the Literature on Spinal Glioma and Ependymoma Including the Oxford Level of Evidence Estimated by the authors

ArticlePatientsTreatmentIrradiation doseSurvival
Corradini et al.13n = 16
7 primary glioma
9 secondary glioma
10 WHO IV
4 WHO III
2 WHO II		RT 16 (10 RT + TMZ)
GTR 1
STR 9
PE 7		Median dose 45Gy (range 30–54Gy)
median dose per fraction 1.8Gy (range 1.8–3.0Gy)		Median OS 6 months
Mean OS ≥ 45Gy 64.0 months vs. mean OS < 45Gy, 2.5 months
(P < .001)
Mean OS Surgery + RT 63.9 months vs. mean RT 2.7 months
(P < .001)
Rodrigues et al.14n = 52
48 astrocytoma
2 oligodendroglioma
2 mixed glioma		RT 52
GTR 5
STR 20
PE 27		median dose 50Gy in 25fx
(20Gy in 10fx to 60Gy in 30fx)		5-y OS 54%
5-y PFS 58%
10-y OS 45%
10-y PFS 43%
Zorlu et al.15n = 26
20 grades I–II
4 grade III		RT 26
GTR 2
STR 10
PE 14		median dose 49.5Gy (range 35–60Gy)
median fraction dose 1.5Gy (range 1–2Gy)		5-y OS 45%
5-y PFS 40%
5-y OS > 45Gy 48% vs. 5-y OS ≤ 45Gy 29%
P = .2
Shirato et al.16n = 36
7 astrocytoma
4 anaplastic astrocytoma
2 glioblastoma
18 ependymoma
4 myxopapillary ependymoma		RT 21
GTR 14 (1 Astrocytoma, 13 Ependymoma)
STR 8
PE 14		Astrocytoma median dose 45Gy (35–50Gy)
High-grade astrocytic tumors 50Gy (40–65Gy)
Ependymal tumors 40Gy (30–50Gy)		5-y OS 96% (ependymoma)
5-y OS 50% (astrocytoma)
Kahn et al.17n = 32
15 ependymoma
17 astrocytoma
1 oligodendroglioma		RT 32 (10 proton)
STR 19 (8 astrocytoma, 11 ependymoma)
PE 11 (8 astrocytoma, 3 ependymoma)		mean 51Gy (n = 22) (range 45–54.45Gy)5-y OS 65%
5-y PFS 61%
5-y OS (ependymoma) 86%
5-y OS (astrocytoma) 52%
Garcia et al.18n = 37 (14 children)
26 intramedullary (14 Astrocytoma, 8 ependymoma, 3 unknown, 1 diffuse histiocytic lymphoma)
11 conus/cauda (1 astrocytoma, 10 ependymoma)		RT 37
GTR 1
STR 8
PE 14		Range 30–50Gy
Range fraction dose 1.7–2.0Gy		5-y OS 70%
10-y OS 58%
<40Gy 90% died of recurrence
≥40Gy 75% control of tumor
Linstadt et al.19n = 42
21 ependymoma
12 low-grade astrocytoma
3 high-grade glioma
39 local RT
3 craniospinal RT		RT 42 (39 local, 3 craniospinal)
GTR 15 (15 ependymoma)
STR 19 (14 ependymoma, 5 astrocytoma)
PE (5 ependymoma, 10 astrocytoma)		Mean 50Gy (range 45.0–54.7Gy) (n = 39)
3 received craniospinal RT		10-y OS 91% (low-grade astrocytoma)
10-y OS 93% (ependymoma)
High-grade astrocytoma lived not longer than 8 months
Sandler et al.20n = 21
18 LGSG
2 HGSG
15 RT
3 GTR, STR 7, PE 11		RT 15
GTR 3
STR 7
PE 11		Range 35.25–60.00 Gy5-y OS 57%
5-y PFS 44%
10-y OS 57%
10-y PFS 30%
Minehan et al.21n = 136
69 pilocytic astrocytoma
40 astrocytoma
19 anaplastic astrocytoma
8 glioblastoma		RT 102
GTR 22
STR 34
PE 80		Median 48.95Gy ± 8.04GyMedian OS (pilocytic) 39.9 years
Median OS (astrocytic) 1.85 years
Median OS (astrocytic) > 35Gy 26 months vs. median OS (astrocytic) ≤ 35Gy: 9 months (P = .04)
Nunna et al.22n = 396 (grade III and IV)RT 277 (78 IMRT, 5 proton)
GTR 23
STR 198
Extent unknown 105		30.9Gy ± 22.9Gy
fraction dose of 1.9Gy ± 6.1Gy		Mean OS 24.5 months
Shaw et al.23n = 22
12 ependymoma
10 myxopapillary ependymoma		RT 8
GTR 8
STR 11
PE 3		Median 50Gy
Range 36–57Gy		5-y and 10-y OS 95%
5-y PFS 81%
10-PFS 71%
≤50Gy 35% failure
>50Gy 20% failure
Choi et al.24n = 45 (all astrocytoma)
WHO I 6
WHO II 14
WHO III 12
WHO IV 13		RT 45 (37 postOp, 6 definitiv, 6 salvage, 4 craniospinal)
GTR 6
STR 18
PTR 6
PE 3		Median 50.4Gy (range 42.5–54.0Gy)
Median fraction 1.8Gy (range 1.5–2.5Gy)		Median OS 52 months
Median PFS 24 months
Byun et al.25n = 25
Grade 1 12
Grade 2 12
Grade 3 1
6 myxopapillary		RT 25 (21 local, 4 craniospinal)Range 44.0–59, 4Gy
Range lumbosacral 57–59, 4Gy
Range cervicothoracic 45–50.4Gy		5-y OS 83.7%
5-y PFS 70.8%
Tsai et al.26n = 51
All myxopapillary		RT 31
GTR 28
STR 22
PE 1		Median 50.4Gy (range 44.2–60Gy)
Median fraction 1.8Gy (range 1.5–2Gy)		median OS 11 y
10-y OS 93%
10-y PFS 63%
Lee SH et al.27n = 88
24 myxopaillary
61 ependymoma
3 anaplastic		RT 20
GTR 72
STR 15
PTR 1		Range 45–50Gy
Range fraction 1.5–2Gy		5-y PFS 87%
10-y PFS 89%
Pica et al.28n = 85
All myxopapillary		RT 47
GTR 40
STR 43
PE 2		Median 50.4Gy (range 22.2–59.4Gy)
Fraction 1.8 (range 1.5–2.0Gy)		5-y PFS 67.5%
5-y PFS OP 50,4%
5-y PFS OP + RT 74, 8%
Wahab et al.29n = 22
Grade 2 13
grade 1 9 (myxopapillary)		RT 22 (20 postOp, 2 salvage)
GTR 2
STR 20		Median 45.0Gy (range 30.0–54.0Gy)
Median fraction 1.8Gy (range 1.5– 2.5Gy)		5-y OS 78%
10-y OS 64%
5-y and 10-y PFS 80%
Akyurek et al.30n = 35
All myxopapillary		RT 22
GTR 21
STR 13
PE 1		Median 50.4Gy (range 44.3–56Gy)
Median fraction 1.8Gy (range 1.5Gy–2Gy)		5-y and 10-y OS 97%
5-y PFS 70%
10-y PFS 62%
Volpp et al.31n = 23
15 ependymoma
6 myxopapillary
2 not given		RT 5
GTR 9
STR 14		Mean 45Gy (range 39–50.4Gy)
Fraction 1.8Gy		5-y OS 77%
9-y OS 63%
ArticlePatientsTreatmentIrradiation doseSurvival
Corradini et al.13n = 16
7 primary glioma
9 secondary glioma
10 WHO IV
4 WHO III
2 WHO II		RT 16 (10 RT + TMZ)
GTR 1
STR 9
PE 7		Median dose 45Gy (range 30–54Gy)
median dose per fraction 1.8Gy (range 1.8–3.0Gy)		Median OS 6 months
Mean OS ≥ 45Gy 64.0 months vs. mean OS < 45Gy, 2.5 months
(P < .001)
Mean OS Surgery + RT 63.9 months vs. mean RT 2.7 months
(P < .001)
Rodrigues et al.14n = 52
48 astrocytoma
2 oligodendroglioma
2 mixed glioma		RT 52
GTR 5
STR 20
PE 27		median dose 50Gy in 25fx
(20Gy in 10fx to 60Gy in 30fx)		5-y OS 54%
5-y PFS 58%
10-y OS 45%
10-y PFS 43%
Zorlu et al.15n = 26
20 grades I–II
4 grade III		RT 26
GTR 2
STR 10
PE 14		median dose 49.5Gy (range 35–60Gy)
median fraction dose 1.5Gy (range 1–2Gy)		5-y OS 45%
5-y PFS 40%
5-y OS > 45Gy 48% vs. 5-y OS ≤ 45Gy 29%
P = .2
Shirato et al.16n = 36
7 astrocytoma
4 anaplastic astrocytoma
2 glioblastoma
18 ependymoma
4 myxopapillary ependymoma		RT 21
GTR 14 (1 Astrocytoma, 13 Ependymoma)
STR 8
PE 14		Astrocytoma median dose 45Gy (35–50Gy)
High-grade astrocytic tumors 50Gy (40–65Gy)
Ependymal tumors 40Gy (30–50Gy)		5-y OS 96% (ependymoma)
5-y OS 50% (astrocytoma)
Kahn et al.17n = 32
15 ependymoma
17 astrocytoma
1 oligodendroglioma		RT 32 (10 proton)
STR 19 (8 astrocytoma, 11 ependymoma)
PE 11 (8 astrocytoma, 3 ependymoma)		mean 51Gy (n = 22) (range 45–54.45Gy)5-y OS 65%
5-y PFS 61%
5-y OS (ependymoma) 86%
5-y OS (astrocytoma) 52%
Garcia et al.18n = 37 (14 children)
26 intramedullary (14 Astrocytoma, 8 ependymoma, 3 unknown, 1 diffuse histiocytic lymphoma)
11 conus/cauda (1 astrocytoma, 10 ependymoma)		RT 37
GTR 1
STR 8
PE 14		Range 30–50Gy
Range fraction dose 1.7–2.0Gy		5-y OS 70%
10-y OS 58%
<40Gy 90% died of recurrence
≥40Gy 75% control of tumor
Linstadt et al.19n = 42
21 ependymoma
12 low-grade astrocytoma
3 high-grade glioma
39 local RT
3 craniospinal RT		RT 42 (39 local, 3 craniospinal)
GTR 15 (15 ependymoma)
STR 19 (14 ependymoma, 5 astrocytoma)
PE (5 ependymoma, 10 astrocytoma)		Mean 50Gy (range 45.0–54.7Gy) (n = 39)
3 received craniospinal RT		10-y OS 91% (low-grade astrocytoma)
10-y OS 93% (ependymoma)
High-grade astrocytoma lived not longer than 8 months
Sandler et al.20n = 21
18 LGSG
2 HGSG
15 RT
3 GTR, STR 7, PE 11		RT 15
GTR 3
STR 7
PE 11		Range 35.25–60.00 Gy5-y OS 57%
5-y PFS 44%
10-y OS 57%
10-y PFS 30%
Minehan et al.21n = 136
69 pilocytic astrocytoma
40 astrocytoma
19 anaplastic astrocytoma
8 glioblastoma		RT 102
GTR 22
STR 34
PE 80		Median 48.95Gy ± 8.04GyMedian OS (pilocytic) 39.9 years
Median OS (astrocytic) 1.85 years
Median OS (astrocytic) > 35Gy 26 months vs. median OS (astrocytic) ≤ 35Gy: 9 months (P = .04)
Nunna et al.22n = 396 (grade III and IV)RT 277 (78 IMRT, 5 proton)
GTR 23
STR 198
Extent unknown 105		30.9Gy ± 22.9Gy
fraction dose of 1.9Gy ± 6.1Gy		Mean OS 24.5 months
Shaw et al.23n = 22
12 ependymoma
10 myxopapillary ependymoma		RT 8
GTR 8
STR 11
PE 3		Median 50Gy
Range 36–57Gy		5-y and 10-y OS 95%
5-y PFS 81%
10-PFS 71%
≤50Gy 35% failure
>50Gy 20% failure
Choi et al.24n = 45 (all astrocytoma)
WHO I 6
WHO II 14
WHO III 12
WHO IV 13		RT 45 (37 postOp, 6 definitiv, 6 salvage, 4 craniospinal)
GTR 6
STR 18
PTR 6
PE 3		Median 50.4Gy (range 42.5–54.0Gy)
Median fraction 1.8Gy (range 1.5–2.5Gy)		Median OS 52 months
Median PFS 24 months
Byun et al.25n = 25
Grade 1 12
Grade 2 12
Grade 3 1
6 myxopapillary		RT 25 (21 local, 4 craniospinal)Range 44.0–59, 4Gy
Range lumbosacral 57–59, 4Gy
Range cervicothoracic 45–50.4Gy		5-y OS 83.7%
5-y PFS 70.8%
Tsai et al.26n = 51
All myxopapillary		RT 31
GTR 28
STR 22
PE 1		Median 50.4Gy (range 44.2–60Gy)
Median fraction 1.8Gy (range 1.5–2Gy)		median OS 11 y
10-y OS 93%
10-y PFS 63%
Lee SH et al.27n = 88
24 myxopaillary
61 ependymoma
3 anaplastic		RT 20
GTR 72
STR 15
PTR 1		Range 45–50Gy
Range fraction 1.5–2Gy		5-y PFS 87%
10-y PFS 89%
Pica et al.28n = 85
All myxopapillary		RT 47
GTR 40
STR 43
PE 2		Median 50.4Gy (range 22.2–59.4Gy)
Fraction 1.8 (range 1.5–2.0Gy)		5-y PFS 67.5%
5-y PFS OP 50,4%
5-y PFS OP + RT 74, 8%
Wahab et al.29n = 22
Grade 2 13
grade 1 9 (myxopapillary)		RT 22 (20 postOp, 2 salvage)
GTR 2
STR 20		Median 45.0Gy (range 30.0–54.0Gy)
Median fraction 1.8Gy (range 1.5– 2.5Gy)		5-y OS 78%
10-y OS 64%
5-y and 10-y PFS 80%
Akyurek et al.30n = 35
All myxopapillary		RT 22
GTR 21
STR 13
PE 1		Median 50.4Gy (range 44.3–56Gy)
Median fraction 1.8Gy (range 1.5Gy–2Gy)		5-y and 10-y OS 97%
5-y PFS 70%
10-y PFS 62%
Volpp et al.31n = 23
15 ependymoma
6 myxopapillary
2 not given		RT 5
GTR 9
STR 14		Mean 45Gy (range 39–50.4Gy)
Fraction 1.8Gy		5-y OS 77%
9-y OS 63%

Abbreviations: 10-y OS = 10-y overall survival; 5-y OS = 5-y overall survival; PE = only biopsy taken; PTR = partial tumor resection; TMZ = temozolomide.

Table 1.
Open in new tab

Overview of the Literature on Spinal Glioma and Ependymoma Including the Oxford Level of Evidence Estimated by the authors

ArticlePatientsTreatmentIrradiation doseSurvival
Corradini et al.13n = 16
7 primary glioma
9 secondary glioma
10 WHO IV
4 WHO III
2 WHO II		RT 16 (10 RT + TMZ)
GTR 1
STR 9
PE 7		Median dose 45Gy (range 30–54Gy)
median dose per fraction 1.8Gy (range 1.8–3.0Gy)		Median OS 6 months
Mean OS ≥ 45Gy 64.0 months vs. mean OS < 45Gy, 2.5 months
(P < .001)
Mean OS Surgery + RT 63.9 months vs. mean RT 2.7 months
(P < .001)
Rodrigues et al.14n = 52
48 astrocytoma
2 oligodendroglioma
2 mixed glioma		RT 52
GTR 5
STR 20
PE 27		median dose 50Gy in 25fx
(20Gy in 10fx to 60Gy in 30fx)		5-y OS 54%
5-y PFS 58%
10-y OS 45%
10-y PFS 43%
Zorlu et al.15n = 26
20 grades I–II
4 grade III		RT 26
GTR 2
STR 10
PE 14		median dose 49.5Gy (range 35–60Gy)
median fraction dose 1.5Gy (range 1–2Gy)		5-y OS 45%
5-y PFS 40%
5-y OS > 45Gy 48% vs. 5-y OS ≤ 45Gy 29%
P = .2
Shirato et al.16n = 36
7 astrocytoma
4 anaplastic astrocytoma
2 glioblastoma
18 ependymoma
4 myxopapillary ependymoma		RT 21
GTR 14 (1 Astrocytoma, 13 Ependymoma)
STR 8
PE 14		Astrocytoma median dose 45Gy (35–50Gy)
High-grade astrocytic tumors 50Gy (40–65Gy)
Ependymal tumors 40Gy (30–50Gy)		5-y OS 96% (ependymoma)
5-y OS 50% (astrocytoma)
Kahn et al.17n = 32
15 ependymoma
17 astrocytoma
1 oligodendroglioma		RT 32 (10 proton)
STR 19 (8 astrocytoma, 11 ependymoma)
PE 11 (8 astrocytoma, 3 ependymoma)		mean 51Gy (n = 22) (range 45–54.45Gy)5-y OS 65%
5-y PFS 61%
5-y OS (ependymoma) 86%
5-y OS (astrocytoma) 52%
Garcia et al.18n = 37 (14 children)
26 intramedullary (14 Astrocytoma, 8 ependymoma, 3 unknown, 1 diffuse histiocytic lymphoma)
11 conus/cauda (1 astrocytoma, 10 ependymoma)		RT 37
GTR 1
STR 8
PE 14		Range 30–50Gy
Range fraction dose 1.7–2.0Gy		5-y OS 70%
10-y OS 58%
<40Gy 90% died of recurrence
≥40Gy 75% control of tumor
Linstadt et al.19n = 42
21 ependymoma
12 low-grade astrocytoma
3 high-grade glioma
39 local RT
3 craniospinal RT		RT 42 (39 local, 3 craniospinal)
GTR 15 (15 ependymoma)
STR 19 (14 ependymoma, 5 astrocytoma)
PE (5 ependymoma, 10 astrocytoma)		Mean 50Gy (range 45.0–54.7Gy) (n = 39)
3 received craniospinal RT		10-y OS 91% (low-grade astrocytoma)
10-y OS 93% (ependymoma)
High-grade astrocytoma lived not longer than 8 months
Sandler et al.20n = 21
18 LGSG
2 HGSG
15 RT
3 GTR, STR 7, PE 11		RT 15
GTR 3
STR 7
PE 11		Range 35.25–60.00 Gy5-y OS 57%
5-y PFS 44%
10-y OS 57%
10-y PFS 30%
Minehan et al.21n = 136
69 pilocytic astrocytoma
40 astrocytoma
19 anaplastic astrocytoma
8 glioblastoma		RT 102
GTR 22
STR 34
PE 80		Median 48.95Gy ± 8.04GyMedian OS (pilocytic) 39.9 years
Median OS (astrocytic) 1.85 years
Median OS (astrocytic) > 35Gy 26 months vs. median OS (astrocytic) ≤ 35Gy: 9 months (P = .04)
Nunna et al.22n = 396 (grade III and IV)RT 277 (78 IMRT, 5 proton)
GTR 23
STR 198
Extent unknown 105		30.9Gy ± 22.9Gy
fraction dose of 1.9Gy ± 6.1Gy		Mean OS 24.5 months
Shaw et al.23n = 22
12 ependymoma
10 myxopapillary ependymoma		RT 8
GTR 8
STR 11
PE 3		Median 50Gy
Range 36–57Gy		5-y and 10-y OS 95%
5-y PFS 81%
10-PFS 71%
≤50Gy 35% failure
>50Gy 20% failure
Choi et al.24n = 45 (all astrocytoma)
WHO I 6
WHO II 14
WHO III 12
WHO IV 13		RT 45 (37 postOp, 6 definitiv, 6 salvage, 4 craniospinal)
GTR 6
STR 18
PTR 6
PE 3		Median 50.4Gy (range 42.5–54.0Gy)
Median fraction 1.8Gy (range 1.5–2.5Gy)		Median OS 52 months
Median PFS 24 months
Byun et al.25n = 25
Grade 1 12
Grade 2 12
Grade 3 1
6 myxopapillary		RT 25 (21 local, 4 craniospinal)Range 44.0–59, 4Gy
Range lumbosacral 57–59, 4Gy
Range cervicothoracic 45–50.4Gy		5-y OS 83.7%
5-y PFS 70.8%
Tsai et al.26n = 51
All myxopapillary		RT 31
GTR 28
STR 22
PE 1		Median 50.4Gy (range 44.2–60Gy)
Median fraction 1.8Gy (range 1.5–2Gy)		median OS 11 y
10-y OS 93%
10-y PFS 63%
Lee SH et al.27n = 88
24 myxopaillary
61 ependymoma
3 anaplastic		RT 20
GTR 72
STR 15
PTR 1		Range 45–50Gy
Range fraction 1.5–2Gy		5-y PFS 87%
10-y PFS 89%
Pica et al.28n = 85
All myxopapillary		RT 47
GTR 40
STR 43
PE 2		Median 50.4Gy (range 22.2–59.4Gy)
Fraction 1.8 (range 1.5–2.0Gy)		5-y PFS 67.5%
5-y PFS OP 50,4%
5-y PFS OP + RT 74, 8%
Wahab et al.29n = 22
Grade 2 13
grade 1 9 (myxopapillary)		RT 22 (20 postOp, 2 salvage)
GTR 2
STR 20		Median 45.0Gy (range 30.0–54.0Gy)
Median fraction 1.8Gy (range 1.5– 2.5Gy)		5-y OS 78%
10-y OS 64%
5-y and 10-y PFS 80%
Akyurek et al.30n = 35
All myxopapillary		RT 22
GTR 21
STR 13
PE 1		Median 50.4Gy (range 44.3–56Gy)
Median fraction 1.8Gy (range 1.5Gy–2Gy)		5-y and 10-y OS 97%
5-y PFS 70%
10-y PFS 62%
Volpp et al.31n = 23
15 ependymoma
6 myxopapillary
2 not given		RT 5
GTR 9
STR 14		Mean 45Gy (range 39–50.4Gy)
Fraction 1.8Gy		5-y OS 77%
9-y OS 63%
ArticlePatientsTreatmentIrradiation doseSurvival
Corradini et al.13n = 16
7 primary glioma
9 secondary glioma
10 WHO IV
4 WHO III
2 WHO II		RT 16 (10 RT + TMZ)
GTR 1
STR 9
PE 7		Median dose 45Gy (range 30–54Gy)
median dose per fraction 1.8Gy (range 1.8–3.0Gy)		Median OS 6 months
Mean OS ≥ 45Gy 64.0 months vs. mean OS < 45Gy, 2.5 months
(P < .001)
Mean OS Surgery + RT 63.9 months vs. mean RT 2.7 months
(P < .001)
Rodrigues et al.14n = 52
48 astrocytoma
2 oligodendroglioma
2 mixed glioma		RT 52
GTR 5
STR 20
PE 27		median dose 50Gy in 25fx
(20Gy in 10fx to 60Gy in 30fx)		5-y OS 54%
5-y PFS 58%
10-y OS 45%
10-y PFS 43%
Zorlu et al.15n = 26
20 grades I–II
4 grade III		RT 26
GTR 2
STR 10
PE 14		median dose 49.5Gy (range 35–60Gy)
median fraction dose 1.5Gy (range 1–2Gy)		5-y OS 45%
5-y PFS 40%
5-y OS > 45Gy 48% vs. 5-y OS ≤ 45Gy 29%
P = .2
Shirato et al.16n = 36
7 astrocytoma
4 anaplastic astrocytoma
2 glioblastoma
18 ependymoma
4 myxopapillary ependymoma		RT 21
GTR 14 (1 Astrocytoma, 13 Ependymoma)
STR 8
PE 14		Astrocytoma median dose 45Gy (35–50Gy)
High-grade astrocytic tumors 50Gy (40–65Gy)
Ependymal tumors 40Gy (30–50Gy)		5-y OS 96% (ependymoma)
5-y OS 50% (astrocytoma)
Kahn et al.17n = 32
15 ependymoma
17 astrocytoma
1 oligodendroglioma		RT 32 (10 proton)
STR 19 (8 astrocytoma, 11 ependymoma)
PE 11 (8 astrocytoma, 3 ependymoma)		mean 51Gy (n = 22) (range 45–54.45Gy)5-y OS 65%
5-y PFS 61%
5-y OS (ependymoma) 86%
5-y OS (astrocytoma) 52%
Garcia et al.18n = 37 (14 children)
26 intramedullary (14 Astrocytoma, 8 ependymoma, 3 unknown, 1 diffuse histiocytic lymphoma)
11 conus/cauda (1 astrocytoma, 10 ependymoma)		RT 37
GTR 1
STR 8
PE 14		Range 30–50Gy
Range fraction dose 1.7–2.0Gy		5-y OS 70%
10-y OS 58%
<40Gy 90% died of recurrence
≥40Gy 75% control of tumor
Linstadt et al.19n = 42
21 ependymoma
12 low-grade astrocytoma
3 high-grade glioma
39 local RT
3 craniospinal RT		RT 42 (39 local, 3 craniospinal)
GTR 15 (15 ependymoma)
STR 19 (14 ependymoma, 5 astrocytoma)
PE (5 ependymoma, 10 astrocytoma)		Mean 50Gy (range 45.0–54.7Gy) (n = 39)
3 received craniospinal RT		10-y OS 91% (low-grade astrocytoma)
10-y OS 93% (ependymoma)
High-grade astrocytoma lived not longer than 8 months
Sandler et al.20n = 21
18 LGSG
2 HGSG
15 RT
3 GTR, STR 7, PE 11		RT 15
GTR 3
STR 7
PE 11		Range 35.25–60.00 Gy5-y OS 57%
5-y PFS 44%
10-y OS 57%
10-y PFS 30%
Minehan et al.21n = 136
69 pilocytic astrocytoma
40 astrocytoma
19 anaplastic astrocytoma
8 glioblastoma		RT 102
GTR 22
STR 34
PE 80		Median 48.95Gy ± 8.04GyMedian OS (pilocytic) 39.9 years
Median OS (astrocytic) 1.85 years
Median OS (astrocytic) > 35Gy 26 months vs. median OS (astrocytic) ≤ 35Gy: 9 months (P = .04)
Nunna et al.22n = 396 (grade III and IV)RT 277 (78 IMRT, 5 proton)
GTR 23
STR 198
Extent unknown 105		30.9Gy ± 22.9Gy
fraction dose of 1.9Gy ± 6.1Gy		Mean OS 24.5 months
Shaw et al.23n = 22
12 ependymoma
10 myxopapillary ependymoma		RT 8
GTR 8
STR 11
PE 3		Median 50Gy
Range 36–57Gy		5-y and 10-y OS 95%
5-y PFS 81%
10-PFS 71%
≤50Gy 35% failure
>50Gy 20% failure
Choi et al.24n = 45 (all astrocytoma)
WHO I 6
WHO II 14
WHO III 12
WHO IV 13		RT 45 (37 postOp, 6 definitiv, 6 salvage, 4 craniospinal)
GTR 6
STR 18
PTR 6
PE 3		Median 50.4Gy (range 42.5–54.0Gy)
Median fraction 1.8Gy (range 1.5–2.5Gy)		Median OS 52 months
Median PFS 24 months
Byun et al.25n = 25
Grade 1 12
Grade 2 12
Grade 3 1
6 myxopapillary		RT 25 (21 local, 4 craniospinal)Range 44.0–59, 4Gy
Range lumbosacral 57–59, 4Gy
Range cervicothoracic 45–50.4Gy		5-y OS 83.7%
5-y PFS 70.8%
Tsai et al.26n = 51
All myxopapillary		RT 31
GTR 28
STR 22
PE 1		Median 50.4Gy (range 44.2–60Gy)
Median fraction 1.8Gy (range 1.5–2Gy)		median OS 11 y
10-y OS 93%
10-y PFS 63%
Lee SH et al.27n = 88
24 myxopaillary
61 ependymoma
3 anaplastic		RT 20
GTR 72
STR 15
PTR 1		Range 45–50Gy
Range fraction 1.5–2Gy		5-y PFS 87%
10-y PFS 89%
Pica et al.28n = 85
All myxopapillary		RT 47
GTR 40
STR 43
PE 2		Median 50.4Gy (range 22.2–59.4Gy)
Fraction 1.8 (range 1.5–2.0Gy)		5-y PFS 67.5%
5-y PFS OP 50,4%
5-y PFS OP + RT 74, 8%
Wahab et al.29n = 22
Grade 2 13
grade 1 9 (myxopapillary)		RT 22 (20 postOp, 2 salvage)
GTR 2
STR 20		Median 45.0Gy (range 30.0–54.0Gy)
Median fraction 1.8Gy (range 1.5– 2.5Gy)		5-y OS 78%
10-y OS 64%
5-y and 10-y PFS 80%
Akyurek et al.30n = 35
All myxopapillary		RT 22
GTR 21
STR 13
PE 1		Median 50.4Gy (range 44.3–56Gy)
Median fraction 1.8Gy (range 1.5Gy–2Gy)		5-y and 10-y OS 97%
5-y PFS 70%
10-y PFS 62%
Volpp et al.31n = 23
15 ependymoma
6 myxopapillary
2 not given		RT 5
GTR 9
STR 14		Mean 45Gy (range 39–50.4Gy)
Fraction 1.8Gy		5-y OS 77%
9-y OS 63%

Abbreviations: 10-y OS = 10-y overall survival; 5-y OS = 5-y overall survival; PE = only biopsy taken; PTR = partial tumor resection; TMZ = temozolomide.

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