Ependymomas are rare primary central nervous system tumors occurring in children and young adults. They can be indolent or locally aggressive depending on location, histology, and extent of resection. Treatment involves maximal surgical resection and usually focal radiation therapy, depending on the presence of residual disease and tumor grade. Chemotherapy has been studied for both adults and children but do not have an established role in adjuvant therapy. In both age groups, treatment with mainly cisplatin based regimens can be considered in the setting of residual disease after surgery or for salvage therapy when surgery or further radiation is not indicated. In children, chemotherapy can be considered in very young children to delay radiation or to increase the likelihood of complete resection in second look surgery. Targeted agents such as bevacizumab and lapatinib do not have a role in adjuvant therapy for ependymomas but are being explored for recurrent disease. This review discusses adjuvant therapy in both adult and child populations.