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Background Little information is available regarding the effect of conventional radiotherapy on glioma-related seizures. Methods In this retrospective study, we analyzed the seizure response and outcome following conventional radiotherapy in a cohort of 43 patients with glioma (33 grade II, 10 grade III) and medically intractable epilepsy. Results At 3 months after radiotherapy, seizure reduction was significant (≥ 50% reduction of frequency compared with baseline) in 31/43 patients (72%) of the whole series and in 25/33 patients (76%) with grade II gliomas, whereas at 12 months seizure reduction was significant in 26/34 (76%) and in 19/25 (76%) patients, respectively. Seizure reduction was observed more often among patients displaying an objective tumor response on MRI, but patients with no change on MRI also had a significant seizure reduction. Seizure freedom (Engel class I) was achieved at 12 months in 32% of all patients and in 38% of patients with grade II tumors. Timing of radiotherapy and duration of seizures prior to radiotherapy were significantly associated with seizure reduction. Conclusions This study showed that a high proportion of patients with medically intractable epilepsy from diffuse gliomas derive a significant and durable benefit from radiotherapy in terms of epilepsy control and that this positive effect is not strictly associated with tumor shrinkage as shown on MRI. Radiotherapy at tumor progression seems as effective as early radiotherapy after surgery. Prospective studies must confirm and better characterize the response to radiotherapy.

BACKGROUND: There is lack of information regarding the natural history and treatment outcome of neoplastic meningitis (NM) from ependymomas of the adult. AIM OF THE STUDY: To retrospectively analyze all patients with biopsy proven adult ependymomas with NM, who were diagnosed and treated at a single neuro-oncological Institution over the last decade. PATIENTS AND METHODS: We collected from the database and follow-up visits 15 evaluable patients (12 males, 3 females) with a median age of 45 (range 20-72). Histological diagnosis was as follows: 6 grade III (40%), 4 grade II (27%) and 5 grade I (myxopapillary) (33%) ependymomas. Overall, median time to NM was 2 years (range: 0-24). NM occurred at diagnosis in 5/15 (33%) and during follow-up in 10/15 (67%): among these latter the primary tumor was under control in 6/10 (60%) and progressive in 4/10 (40%). All but 4 patients were symptomatic and MRI of the whole CNS was available in all patients. The diagnosis of NM was CSF-based in 7/15 (47%) and radiologically-based in 8/15 (53%). RT to the bulky disease was applied in 7/15 (47%) and surgery in 2/15 (13%). Medical therapies consisted variably in intrathecal Depocyte, temozolomide, nitrosourea-based regimens and bevacizumab. Four out of 12 symptomatic patients had a significant clinico-radiological response. Median survival was 20 months (range: 1 month-7 years), and 7/15 patients are still alive. CONCLUSIONS: NM from ependymomas in the adult is more indolent compared with other NM types, with longer survivals after multimodality treatment. Prospective studies are warranted.