If it is feasible: surgery, but it is mostly improbable that a new surgery could reach a good resection grade without neurological deficit. If surgery is not possible, there are not many things to do. It is possible try with radio surgery (there are some reports for intracranial and spinal recurrent ependymomas and some about what to do: http://link.springer.com/journal/11060/116/1/page/1;http://link.springer.com/journal/10143;http://www.biomedcentral.com/content/pdf/1756-0500-7-908.pdf.; http://link.springer.com/journal/11864). Other possibilities include chemotherapy: http://link.springer.com/journal/11060; http://thejns.org/doi/abs/10.3171/2013.3.SPINE12183. Good luck

First approach is to make sure pal care are involved I would think.  You didn't mention the age of your patient but given the diagnosis and location I'm guessing adult.  I'm a paed onc so my answer will be skewed in this direction.  In children ependymomas often achieve a longer second remission after reirradiation but this study did not include spinal patients.

"Bouffet E. Survival benefit for pediatric patients with recurrent ependymoma treated with reirradiation. International journal of radiation oncology, biology, physics 2012"

If you haven't already checked out the latest work on molecular classification I suggest you do, although it probably doesn't hold many answers for your patient.

"Pajtler K. Molecular Classification of Ependymal Tumors across All CNS Compartments, Histopathological Grades, and Age Groups.  Cancer Cell 2015"

Chemotherapy has no proven efficacy in ST or PF ependymoma other than holding tumours for second resection.  I'm not sure about spinal but I suspect the evidence is slim.  Newer phase I/II trials of 5-FU as a single agent and gemcitibine as a single agent have shown little efficacy (in children at least).

I would suggest surgery as far as possible and reirradiation if sufficient time has passed for the rad onc to be happy.  Good luck.

In spinal anaplastic ependymoma first of all we need to see the time since radiation.

Secondly, we need to ascertain if it is associated with NF2 mutation.

Surgery remains the most important treatment option.

Re-irradiation may be an option if long time has lapsed after radiation (as there is conflicting data regarding spine tolerance).

There is no data for salvage chemotherapy. However, one may try Temozolomide or Bevacizumab.

But, if NF-2 mutation is there, mTOR inhibitors may work.

I fully agree with Supriya Mallick. The imprtant factor you did not mention is also the localisation (level) of the spinal recurrent.

Best regards!

In addition to the options previously listed, I know MD Anderson had a trial of using bevacizumab combined with carboplatin for recurrent ependymomas.  At the very least I would consider bevacizumab, as it would likely be well-tolerated.  There are no definitive studies of efficacy, but some anecdotal experience suggests some period of stability.

I would add it depends a lot if it was single or multiple if single and can be resected safely which is rare. I'd go with surgery followed by chemo and radiation. I'd also speak with the patient regarding operative, chemo and rad risks on neurological function.