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Hersh AM, Jallo GI, Shimony N. Surgical approaches to intramedullary spinal cord astrocytomas in the age of genomics. Front Oncol 2022; 12:982089. [PMID: 36147920 PMCID: PMC9485889 DOI: 10.3389/fonc.2022.982089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/11/2022] [Indexed: 11/25/2022] Open
Abstract
Intramedullary astrocytomas represent approximately 30%–40% of all intramedullary tumors and are the most common intramedullary tumor in children. Surgical resection is considered the mainstay of treatment in symptomatic patients with neurological deficits. Gross total resection (GTR) can be difficult to achieve as astrocytomas frequently present as diffuse lesions that infiltrate the cord. Therefore, GTR carries a substantial risk of new post-operative deficits. Consequently, subtotal resection and biopsy are often the only surgical options attempted. A midline or paramedian sulcal myelotomy is frequently used for surgical resection, although a dorsal root entry zone myelotomy can be used for lateral tumors. Intra-operative neuromonitoring using D-wave integrity, somatosensory, and motor evoked potentials is critical to facilitating a safe resection. Adjuvant radiation and chemotherapy, such as temozolomide, are often administered for high-grade recurrent or progressive lesions; however, consensus is lacking on their efficacy. Biopsied tumors can be analyzed for molecular markers that inform clinicians about the tumor’s prognosis and response to conventional as well as targeted therapeutic treatments. Stratification of intramedullary tumors is increasingly based on molecular features and mutational status. The landscape of genetic and epigenetic mutations in intramedullary astrocytomas is not equivalent to their intracranial counterparts, with important difference in frequency and type of mutations. Therefore, dedicated attention is needed to cohorts of patients with intramedullary tumors. Targeted therapeutic agents can be designed and administered to patients based on their mutational status, which may be used in coordination with traditional surgical resection to improve overall survival and functional status.
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Affiliation(s)
- Andrew M. Hersh
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - George I. Jallo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neurosurgery, Johns Hopkins Medicine, Institute for Brain Protection Sciences, Johns Hopkins All Children’s Hospital, St. Petersburg, FL, United States
- *Correspondence: George I. Jallo,
| | - Nir Shimony
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, TN, United States
- Le Bonheur Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, TN, United States
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, United States
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Hersh AM, Patel J, Pennington Z, Porras JL, Goldsborough E, Antar A, Elsamadicy AA, Lubelski D, Wolinsky JP, Jallo G, Gokaslan ZL, Lo SFL, Sciubba DM. Perioperative outcomes and survival after surgery for intramedullary spinal cord tumors: a single-institution series of 302 patients. J Neurosurg Spine 2022; 37:252-262. [PMID: 35213831 DOI: 10.3171/2022.1.spine211235] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/03/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intramedullary spinal cord tumors (IMSCTs) are rare neoplasms whose treatment is often technically challenging. Given the low volume seen at most centers, perioperative outcomes have been reported infrequently. Here, the authors present the largest single-institution series of IMSCTs, focusing on the clinical presentation, histological makeup, perioperative outcomes, and long-term survival of surgically treated patients. METHODS A cohort of patients operated on for primary IMSCTs at a comprehensive cancer center between June 2002 and May 2020 was retrospectively identified. Data on patient demographics, tumor histology, neuraxial location, baseline neurological status, functional deficits, and operative characteristics were collected. Perioperative outcomes of interest included length of stay, postoperative complications, readmission, reoperation, and discharge disposition. Data were compared across tumor histologies using the Kruskal-Wallis H test, chi-square test, and Fisher exact test. Pairwise comparisons were conducted using Tukey's honest significant difference test, chi-square test, and Fisher exact test. Long-term survival was assessed across tumor categories and histological subtype using the log-rank test. RESULTS Three hundred two patients were included in the study (mean age 34.9 ± 19 years, 77% white, 57% male). The most common tumors were ependymomas (47%), astrocytomas (31%), and hemangioblastomas (11%). Ependymomas and hemangioblastomas disproportionately localized to the cervical cord (54% and 59%, respectively), whereas astrocytomas were distributed almost equally between the cervical cord (36%) and thoracic cord (38%). Clinical presentation, extent of functional dependence, and postoperative 30-day outcomes were largely independent of underlying tumor pathology, although tumors of the thoracic cord had worse American Spinal Injury Association (ASIA) grades than cervical tumors. Rates of gross-total resection were lower for astrocytomas than for ependymomas (54% vs 84%, p < 0.01) and hemangioblastomas (54% vs 100%, p < 0.01). Additionally, 30-day readmission rates were significantly higher for astrocytomas than ependymomas (14% vs 6%, p = 0.02). Overall survival was significantly affected by the underlying pathology, with astrocytomas having poorer associated prognoses (40% at 15 years) than ependymomas (81%) and hemangioblastomas (66%; p < 0.01) and patients with high-grade ependymomas and astrocytomas having poorer long-term survival than those with low-grade lesions (p < 0.01). CONCLUSIONS The neuraxial location of IMSCTs, extent of resection, and postoperative survival differed significantly across tumor pathologies. However, perioperative outcomes did not vary significantly across tumor cohorts, suggesting that operative details, rather than pathology, may have a stronger influence on the short-term clinical course, whereas pathology appears to have a stronger impact on long-term survival.
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Affiliation(s)
- Andrew M Hersh
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jaimin Patel
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Zach Pennington
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Jose L Porras
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Earl Goldsborough
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Albert Antar
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Daniel Lubelski
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jean-Paul Wolinsky
- 4Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - George Jallo
- 5Department of Neurosurgery, Johns Hopkins Medicine, Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Ziya L Gokaslan
- 6Department of Neurosurgery, Brown University, Providence, Rhode Island; and
| | - Sheng-Fu Larry Lo
- 7Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Daniel M Sciubba
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- 7Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, New York
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Seaman SC, Bathla G, Park BJ, Woodroffe RW, Smith M, Menezes AH, Noeller J, Yamaguchi S, Hitchon PW. MRI characteristics and resectability in spinal cord glioma. Clin Neurol Neurosurg 2021; 200:106321. [PMID: 33268194 DOI: 10.1016/j.clineuro.2020.106321] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/14/2020] [Accepted: 10/16/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The histopathology of intramedullary spinal cord tumors (IMSCT) can be suspected from the MRI features and characteristics. Ultimately, the confirmation of diagnosis requires surgery. This retrospective study addresses MRI features including homogeneity of enhancement, margination, and associated syrinx in intramedullary astrocytomas (IMA) and ependymomas (IME) that assist in diagnosis and predict resectability of these tumors. METHODS Single-center retrospective analysis of IMA and IME cases since 2005 extracted from the departmental registry/electronic medical records post IRB approval (IRB 201,710,760). We compared imaging findings (enhancement, margination, homogeneity, and associated syrinxes) between tumor types and examined patient outcomes. RESULTS There were 18 IME and 21 IMA. On preoperative MRI, IME was favored to have homogenous enhancement (OR 1.8, p = 0.0001), well-marginated (p < 0.0001, OR 0.019 [95 % CI 0.002-0.184]), and associated syrinx (p = 0.015, OR 0.192 [95 % CI 0.049-0.760]). Total excision, subtotal excision, and biopsy were performed in 12, 5, and 1 patients in the IME cohort, respectively. In the IMA group, tumors were heterogeneous and poorly marginated in 20 of the 21 patients. Total excision, subtotal excision, and biopsy were undertaken in 2, 13, and 6 patients, respectively. The success of excision was predicted by MRI, with a significant difference in the extent of resection between IME and IMA (X2 = 14.123, p = 0.001). In terms of outcome, ordinal regression analysis showed that well-margined tumors and those with homogeneous enhancement were associated with a better postoperative McCormick score. Extent of resection had statistically significant survival (p = 0.026) and recurrence-free survival (p = 0.008) benefits. CONCLUSION The imaging characteristics of IME and IMA have meaningful clinical significance. Homogeneity, margination, and associated syrinxes in IME can predict resectability and complexity of surgery.
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Affiliation(s)
- Scott C Seaman
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA USA
| | - Girish Bathla
- Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA USA
| | - Brian J Park
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA USA
| | - Royce W Woodroffe
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA USA
| | - Mark Smith
- Department of Radiation Oncology, University of Iowa Carver College of Medicine, Iowa City, IA USA
| | - Arnold H Menezes
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA USA
| | - Jennifer Noeller
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA USA
| | - Satoshi Yamaguchi
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA USA
| | - Patrick W Hitchon
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA USA.
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Chou SC, Kuo MF, Lai DM, Chen CM, Xiao F, Tsuang FY, Yang SH. Contemporary management of pediatric spinal tumors: a single institute's experience in Taiwan in the modern era. J Neurooncol 2020; 146:501-511. [PMID: 32020480 DOI: 10.1007/s11060-020-03400-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/13/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Pediatric spinal tumors are unique pathologies treated by pediatric neurosurgeons. Special attention is required for the preservation of neural function and bony alignment. We reported our experience in the management of these challenging lesions. METHODS A total of 75 pediatric patients with spinal tumors treated at the National Taiwan University Hospital from 1998 to 2018 were identified retrospectively. Clinical data, radiographic image, and pathological report were reviewed for analysis. RESULTS There were 37 females and 38 males. The median age was 9 years. Thirty-eight tumors (50.6%) were extradural, 20 (26.7%) intradural extramedullary, and 17 (22.6%) intramedullary. The most common pathologies were glioma, ependymoma, and neuroblastoma. The rate of total and subtotal resection was 45.3% and 21.3%. Thirty-four patients (45.3%) required post-operative adjuvant therapy. Eight patients (10.6%) with spinal deformity had simultaneous tumor excision and spinal fusion surgery. Additional six (8%) patients had subsequent spinal fixation and fusion for deformity after primary tumor operation. Eighty-four percent of patients were ambulatory 3 years after operation. For patients with intradural extramedullary and intramedullary tumors, worse survival outcome was associated with tumor derived from CSF seeding and cranial involvement of spinal tumor, while poorer functional outcome was correlated with cranial involvement and adjuvant therapy with chemotherapy or radiotherapy. CONCLUSIONS Pediatric spinal tumor surgery carries low surgical morbidity and mortality under current standard of neurosurgical practice. Post-operative adjuvant therapy is required for nearly half of the cases. Spinal deformity requires special attention and sometimes surgical correction. Contemporary management of pediatric spinal tumors enables effective ablation of the lesion and delivers favorable outcome for the majority of patients.
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Affiliation(s)
- Sheng-Che Chou
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei City, Taiwan.,Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Douliou City, Yun-Lin County, Taiwan
| | - Meng-Fai Kuo
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Dar-Ming Lai
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Chang-Mu Chen
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Furen Xiao
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Fon-Yih Tsuang
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Shih-Hung Yang
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei City, Taiwan.
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Sanei-Sistani S, Miri-Aliabad G, Dahmardeh H, Montazeran M, Jahantigh M, Zare M. Intracranial Metastases of Intramedullary Spinal Cord Low-Grade Astrocytoma. Indian J Med Paediatr Oncol 2020. [DOI: 10.4103/ijmpo.ijmpo_64_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AbstractThis paper reports a case of intramedullary spinal cord low-grade (LG) astrocytoma that developed brain metastases after 21 months. A 6-year-old child presented with lower spine pain and falls during daily activity. A spinal cord mass was detected using spinal magnetic resonance imaging (MRI), and brain MRI was normal. The spinal lesion was partially resected, and pathological findings revealed LG astrocytoma (WHO Grade II). The patient underwent thoracolumbar radiotherapy. He returned 21 months following initial admission with symptoms of nausea, vomiting, headaches, and seizure. Brain MRI revealed multiple intracranial masses at the posterior fossa, left lateral ventricle, cerebellopontine angles, and left Meckel cave. A recurrent lesion was detected in the thoracic and lumbar regions of the spinal cord and in the cauda equina. The patient underwent chemotherapy. This rare case warns practitioners to monitor closely the cases of spinal cord astrocytoma that are diagnosed as LG tumors based on histology.
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Affiliation(s)
| | - Ghasem Miri-Aliabad
- Children and Adolescent Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Hamid Dahmardeh
- Department of Radiology, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mahdieh Montazeran
- Department of Radiology, Zahedan University of Medical Sciences, Zahedan, Iran
- Department of Radiology B, University Hospital of Strasbourg–Hôpital Civil 1, Place de l’Hôpital, 67091 Strasbourg Cedex, France
| | - Mehdi Jahantigh
- Department of Pathology, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mohsen Zare
- ERCOS Group (pole), Laboratory of ELLIAD-EA4661, UTBM-University of Bourgogne Franche-Comté, Belfort, France
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Abstract
Pediatric central nervous system (CNS) tumors are the most common solid tumors in children and comprise 15% to 20% of all malignancies in children. Presentation, symptoms, and signs depend on tumor location and age of the patient at the time of diagnosis. This article summarizes the common childhood CNS tumors, presentations, classification, and recent updates in treatment approaches due to the increased understanding of the molecular pathogenesis of pediatric brain tumors.
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Affiliation(s)
- Yoko T Udaka
- The Brain Tumor Institute, Center for Neuroscience and Behavioral Medicine, Children's National Health System, 111 Michigan Avenue Northwest, Washington, DC 20010, USA; Division of Oncology, Center for Cancer and Blood Disorders, 111 Michigan Avenue Northwest, Washington, DC 20010, USA
| | - Roger J Packer
- The Brain Tumor Institute, Center for Neuroscience and Behavioral Medicine, Children's National Health System, 111 Michigan Avenue Northwest, Washington, DC 20010, USA; The Brain Tumor Institute, Gilbert Family Neurofibromatosis Institute, Children's National Medical Center, 111 Michigan Avenue Northwest, Washington, DC 20010, USA.
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7
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Chang KW, Noh SH, Park JY, Cho YE, Chin DK. Retrospective Study on Accuracy of Intraoperative Frozen Section Biopsy in Spinal Tumors. World Neurosurg 2019; 129:e152-e157. [PMID: 31108252 DOI: 10.1016/j.wneu.2019.05.080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 05/08/2019] [Accepted: 05/09/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Histologic types and grades are critical in the diagnosis and treatment of spinal tumors. Intraoperative frozen section is a fast and easy method in confirming pathologic diagnosis during the operation. This study was undertaken to reveal the accuracy of intraoperative frozen section biopsy in order to make proper treatment plans. METHODS This retrospective study concerned patients who underwent spinal tumor surgeries from 1 January, 2012 to 31 December, 2016. Frozen section biopsy and permanent biopsy were compared, and cases that had differences were counted. RESULTS Thirty-seven cases out of 324 patients had discrepancies (11.4%). In discrepant cases 11 cases were ependymoma (29.7%) and 6 cases were schwannoma (16.2%). Among 34 patients who were finally diagnosed with an ependymoma, 11 cases had discrepancies, which was the highest mismatch rate among tumor final pathologic types. By frozen biopsy, astrocytoma (n = 5) and ependymoma (n = 5) turned out to be the most discrepant pathologic types and 16 frozen section biopsy cases were "null." Frozen biopsy astrocytoma (n = 5) mostly turned out to be ependymoma in 4 cases. CONCLUSIONS Pathologic findings from frozen biopsy for spinal cord tumors could not be corresponded to final diagnosis, especially when the results of frozen biopsy were ependymoma or astrocytoma. Therefore careful decision making for treatment plans is required.
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Affiliation(s)
- Kyung Won Chang
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Hyun Noh
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong-Yoon Park
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Eun Cho
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dong-Kyu Chin
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea.
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Hamilton KR, Lee SS, Urquhart JC, Jonker BP. A systematic review of outcome in intramedullary ependymoma and astrocytoma. J Clin Neurosci 2019; 63:168-175. [PMID: 30833131 DOI: 10.1016/j.jocn.2019.02.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 01/29/2019] [Accepted: 02/20/2019] [Indexed: 01/15/2023]
Abstract
The objective was to determine the impact of surgical resection and adjuvant therapies on survival in intramedullary ependymoma and astrocytoma. Secondary goals were to determine predictors of survival in surgical patients including histological grading, age and gender. Searching of Medline, Embase and Clinicaltrials.gov databases were performed. Multivariate analyses were performed for overall survival (OS) and progression-free survival (PFS) through Monte Carlo methods and Maximum Likelihood Estimation. 57 articles detail results for 3022 patients. Meta-analysis revealed the following factors to have a statistically significant effect on OS. Patients undergoing gross-total resection (GTR) are 5.37 times more likely to survive than patients with lesser volumes of tumor resected (HR for OS 1.68, p < 0.01). High-grade tumors were associated with a 14 times risk of death over low-grade tumors (HR for OS 2.64, p < 0.01). Radiation increased the risk of mortality in low-grade tumors (HR for OS 5.20, p < 0.01), but decreased mortality in high-grade lesions (HR for OS 2.46, p < 0.01). Adult patients were more likely to die from disease compared with pediatric patients by a factor of 1.6 (HR for OS 0.47, p < 0.01). In PFS, radiotherapy was associated with a reduced time to recurrence (HR for PFS 1.90, p < 0.01). There was a male predominance of 58%. Gender did not influence survival. 79% of patients demonstrated stable or improved functional neurological outcomes six months post-operatively. Our data indicates GTR improves OS in all tumor grades. Radiation improves OS only in the presence of high-grade histology. Advancing age and high-grade histology are negative prognostic indicators.
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Affiliation(s)
- Kirsty R Hamilton
- Department of Neurosurgery, Sir Charles Gardner Hospital, Hospital Ave, Nedlands, WA 6009, Australia.
| | - Sharon Si Lee
- Department of Neurosurgery, Perth Children's Hospital, 15 Hospital Ave, Nedlands, WA 6009, Australia.
| | - James C Urquhart
- Queensland University of Technology, 2 George St, Brisbane City, QLD 4000, Australia.
| | - Benjamin P Jonker
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown, NSW 2050, Australia.
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Abd-El-Barr MM, Huang KT, Moses ZB, Iorgulescu JB, Chi JH. Recent advances in intradural spinal tumors. Neuro Oncol 2019; 20:729-742. [PMID: 29216380 DOI: 10.1093/neuonc/nox230] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Intradural spinal tumors are rare tumors of the central nervous system. Due to the eloquence of the spinal cord and its tracts, the compact architecture of the cord and nerves, and the infiltrative nature of some of these tumors, surgical resection is difficult to achieve without causing neurological deficits. Likewise, chemotherapy and radiotherapy are utilized more cautiously in the treatment of intradural spinal tumors than their cranial counterparts. Targeted therapies aimed at the genetic alterations and molecular biology tailored to these tumors would be helpful but are lacking.Here, we review the major types of intradural spinal tumors, with an emphasis on genetic alterations, molecular biology, and experimental therapies for these difficult to treat neoplasms.
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Affiliation(s)
- Muhammad M Abd-El-Barr
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kevin T Huang
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ziev B Moses
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - J Bryan Iorgulescu
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - John H Chi
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Luksik AS, Garzon-Muvdi T, Yang W, Huang J, Jallo GI. Pediatric spinal cord astrocytomas: a retrospective study of 348 patients from the SEER database. J Neurosurg Pediatr 2017; 19:711-719. [PMID: 28362182 DOI: 10.3171/2017.1.peds16528] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Intramedullary spinal cord tumors comprise 1%-10% of all childhood central nervous system neoplasms, with astrocytomas representing the most common subtype. Due to their rarity and poor prognosis, large population-based studies are needed to assess the epidemiology and survival risk factors associated with these tumors in the hope of improving outcome. The authors undertook this retrospective study to explore factors that may influence survival in pediatric patients with spinal cord astrocytomas. METHODS Utilizing the Surveillance, Epidemiology, and End Results (SEER) database, a prospective cancer registry, the authors retrospectively assessed survival in histologically confirmed, primary spinal cord astrocytomas in patients 21 years of age and younger. Survival was described with Kaplan-Meyer curves, and a multivariate regression analysis was used to assess the association of several variables with survival while controlling for confounding variables. RESULTS This analysis of 348 cases showed that age (hazard ratio [HR] 1.05, 95% CI 1.01-1.09, p = 0.017), nonwhite race (HR 1.74, 95% CI 1.11-2.74, p = 0.014), high-grade tumor status (HR 14.67, 95% CI 6.69-32.14, p < 0.001), distant or invasive extension of the tumor (HR 2.37, 95% CI 1.02-5.49, p = 0.046), and radiation therapy (HR 3.74, 95% CI 2.18-6.41, p < 0.001) were associated with decreased survival. Partial resection (HR 0.37, 95% CI 0.16-0.83, p = 0.017) and gross-total resection (HR 0.39, 95% CI 0.16-0.95, p = 0.039) were associated with improved survival. CONCLUSIONS Younger age appears to be protective, while high-grade tumors have a much worse prognosis. Early diagnosis and access to surgery appears necessary for improving outcomes, while radiation therapy has an unclear role. There is still much to learn about this disease in the hope of curing children with the misfortune of having one of these rare tumors.
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Affiliation(s)
- Andrew S Luksik
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Tomas Garzon-Muvdi
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Wuyang Yang
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Judy Huang
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - George I Jallo
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland; and.,Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
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