Response of recurrent anaplastic ependymoma to a combination of tamoxifen and isotretinoin

Standard treatment for brain ependymomas includes surgery followed by focal radiotherapy when resection is incomplete. The role of chemotherapy for recurrent unresectable anaplastic ependymomas previously treated with radiotherapy is unsettled.1 We report an adult patient with a recurrent and multifocal anaplastic brain ependymoma who responded to the association of tamoxifen and isotretinoin. A 39-year-old man developed severe headaches in June 1997. A brain CT and MRI disclosed the presence of mild hydrocephaly and a right bulboprotuberantial heterogeneous tumor which enhanced after contrast infusion. A ventriculoperitoneal derivation was performed followed by an incomplete resection of the tumor. Histologic analysis revealed an anaplastic ependymoma. Focal radiotherapy (60 Gy) using conventional 2-Gy fractions was delivered between August 12, 1997, and September 23, 1997. In June 1998, the patient had recurrent headache and altered equilibrium and an MRI showed a heterogeneous enhancing lesion at the lateral edge of the pons invading the fourth …