Anaplastic Ependymoma (WHO Grade III)

Abstract

An 18-year-old male presented with medication-controlled generalized tonic-clonic seizures, and mild right-sided body weakness, following previous treatments. He had a history of multiple craniotomies, conventional radiation therapy (XRT), and chemotherapy for high-grade glioma. The patient was treated with salvage; Linac-based SRS for progressive residual (post-multiple surgeries, post-XRT, and post-chemotherapy), left temporal, anaplastic ependymoma (WHO Grade III). The target volume of 18.2 cc received a marginal dose of 15.0 Gy normalized to 80% isodose line. During clinical follow-up, the patient remained stable until 16 months post-SRS, when he experienced worsening headache, recurrence of seizure, and started treatment with steroids and diuretics. Initial follow-up MRIs showed a progressive decrease in tumor size and marked loss of central tumor contrast enhancement. From 16 months post-SRS, follow-up MRIs demonstrated a progressive marked increase in tumor size, markedly increased tumor contrast enhancement, and extensive peritumoral edema. Based on the documented failure of salvage radiosurgery treatment to control tumor growth, the patient was scheduled to undergo surgical excision of the progressive tumor.