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      Surgical Outcomes of High-Grade Spinal Cord Gliomas

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          Abstract

          Study Design

          A retrospective study.

          Purpose

          The purpose of this study was to obtain useful information for establishing the guidelines for treating high-grade spinal cord gliomas.

          Overview of Literature

          The optimal management of high-grade spinal cord gliomas remains controversial. We report the outcomes of the surgical management of 14 high-grade spinal glioma.

          Methods

          We analyzed the outcomes of 14 patients with high-grade spinal cord gliomas who were surgically treated between 1989 and 2012. Survival was charted with the Kaplan-Meier plots and comparisons were made with the log-rank test.

          Results

          None of the patients with high-grade spinal cord gliomas underwent total resection. Subtotal resection was performed in two patients, partial resection was performed in nine patients, and open biopsy was performed in three patients. All patients underwent postoperative radiotherapy and six patients further underwent radiation cordotomy. The median survival time for patients with high-grade spinal cord gliomas was 15 months, with a 5-year survival rate of 22.2%. The median survival time for patients with World Health Organization grade III tumors was 25.5 months, whereas the median survival time for patients with glioblastoma multiforme was 12.5 months. Both univariate and multivariate Cox proportional hazards models demonstrated a significant effect only in the group that did not include cervical cord lesion as a factor associated with survival ( p=0.04 and 0.03).

          Conclusions

          The surgical outcome of patients diagnosed with high-grade spinal cord gliomas remains poor. Notably, only the model which excluded cervical cord lesions as a factor significantly predicted survival.

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          Most cited references17

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          Descriptive epidemiology of primary spinal cord tumors.

          J Villano, Kate Schellinger, Christina B. McCarthy … (2008)
          There is little population-based data available on primary spinal cord tumors. Many of the existing statistics are not current or were obtained from surgical series. Historically, population-based data were collected only for malignant tumors, and only recently have data begun to be collected on non-malignant tumors. The objective of this study was to estimate the incidence of both non-malignant and malignant primary spinal cord tumors and to estimate the survival rates for primary malignant spinal cord tumors. Incidence of spinal cord tumors was estimated from cases diagnosed between 1998 and 2002 in 16 CBTRUS collaborating state cancer registries. Age-adjusted rates were generated using SAS (8.2) and standardized to the 2000 US standard population. SEER*Stat 6.1.4 software was used to estimate relative survival for malignant spinal cord tumors for cases diagnosed between 1975 and 2002 in nine SEER regions. Of the spinal cord tumors identified (CBTRUS; n = 3,226), 69% were non-malignant. The most common histologic types were meningiomas (29%), nerve sheath tumors (24%), and ependymomas (23%). The overall incidence of spinal cord tumors was 0.74 per 100,000 person-years, with an incidence of 0.77/100,000 in females and 0.70/100,000 in males. The incidence rate was lowest in children (0.26) and peaked in the 75-84 year age group (1.80). Rates were higher in non-Hispanic whites (0.79) than in Hispanics (0.61) or non-Hispanic blacks (0.45). The 1-, 5-, and 10-year survival rates following diagnosis of a primary malignant spinal cord tumor were 85%, 71%, and 64%, respectively (SEER; n = 1,220).
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            Long-term follow-up of intramedullary spinal cord tumors: a series of 202 cases.

            Roberto Delfini, Manolo Piccirilli, Jacopo Lenzi … (2005)
            To review a series of patients who underwent surgical removal of intramedullary spinal cord tumors, focusing on the long-term functional outcome, recurrence rates for the various tumors, and technical problems continually debated in neurosurgical practice. From December 1972 to June 2003, 202 patients underwent removal of intramedullary tumors. Lesions were located in the cervical spinal cord in 61 patients (30%), at a dorsal site in 60 (29%), at a cervicodorsal site in 51 (25%), and in the medullary cone in 30 (15%). The most frequent histological tumor types were astrocytomas (86 patients, 42%) and ependymomas (68 patients, 34%). Of the 68 ependymomas, 55 (81%) were completely removed and 13 (19%) incompletely removed. In 66% of the patients (42 patients), the presenting signs and symptoms remained unchanged at long-term follow-up; in 25% (16 patients), they improved; and in 9% (6 patients), the clinical status worsened. Of the 27 Grade I astrocytomas, 22 (81%) were completely removed and 5 (19%) incompletely removed. Functional assessment of the 23 patients available at "late" follow-up showed that 26% (6 of 23 patients) had improved, 9% (2 of 23 patients) had worsened, and 66% (15 of 23 patients) remained unchanged from preoperative status. Conversely, of the 41 Grade II astrocytomas, only 5 (12%) were completely removed, and 10% had improved. None of the 18 Grade III to IV astrocytomas could be completely removed. In 61% (11 of 18 patients), the postoperative functional status worsened. Determinant predictors of a good outcome after surgery for intramedullary spinal cord tumors are histological type of lesion, complete removal of the lesion, and a satisfactory neurological status before surgery.
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              Radical excision of intramedullary spinal cord tumors: surgical morbidity and long-term follow-up evaluation in 164 children and young adults.

              Peter J. Allen, Robert Miller, L Rorke … (2000)
              The majority of intramedullary spinal cord tumors (IMSCT) in children and young adults are low-grade gliomas. Radical resection of similar tumors in the cerebral hemisphere or cerebellum is usually curative; however, the conventional management for IMSCTs remains partial resection followed by radiotherapy because of the concern for surgical morbidity. Nevertheless, radical resection of IMSCTs without routine adjuvant treatment has been the rule at our institution since 1980. In an attempt to resolve this controversy, the long-term morbidity and survival in a large series of children have been retrospectively reviewed. The database records and current status of 164 patients 21 years of age and younger in whom an IMSCT was resected were reviewed. A gross-total resection (>95%) was achieved in 76.8% of the surgical procedures. Subtotal resections (80-95%) were performed in 20. 1%. The majority of patients (79.3%) had histologically low-grade lesions. There were no deaths due to surgery. When comparing the preoperative and 3-month postoperative functional grades, 60.4% stayed the same, 15.8% improved, and 23.8% deteriorated. Only 13 patients deteriorated by more than one functional grade. Patients with either no deficits or only mild deficits before surgery were rarely injured by the procedure, reinforcing the importance of early diagnosis and treatment. The major determinant of long-term patient survival was histological composition of the tumor. The 5-year progression-free survival rate was 78% for patients with low-grade gliomas and 30% for those with high-grade gliomas. Patients in whom an IMSCT was only partially resected (<80%) fared significantly worse. The long-term survival and quality of life for patients with low-grade gliomas treated by radical resection alone is comparable or superior to minimal resection and radiotherapy. The optimum therapy for patients with high-grade gliomas is yet to be determined.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Asian Spine J
                Journal ID (iso-abbrev): Asian Spine J
                Journal ID (publisher-id): ASJ
                Title: Asian Spine Journal
                Publisher: Korean Society of Spine Surgery
                ISSN (Print): 1976-1902
                ISSN (Electronic): 1976-7846
                Publication date (Print): December 2015
                Publication date (Electronic): 08 December 2015
                Volume: 9
                Issue: 6
                Pages: 935-941
                Affiliations
                [1 ]Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
                [2 ]Sapporo Azabu Neurosurgical Hospital, Sapporo, Hokkaido, Japan.
                [3 ]Department of Orthopedic Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan.
                [4 ]Hokkaido Neurosurgical Memorial Hospital, Sapporo, Hokkaido, Japan.
                Author notes
                Corresponding author: Toshitaka Seki. Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North-15 West-7, Kita-ku, Sapporo 060-8638, Hokkaido, Japan. Tel: +81-11-706-5987, Fax: +81-11-708-7737, toseki1@ 123456hotmail.com
                Article
                DOI: 10.4184/asj.2015.9.6.935
                PMC ID: 4686401
                PubMed ID: 26713128
                SO-VID: 0e45c7a0-282e-4d4f-8032-7c2cfa9e69a5
                Copyright © Copyright © 2015 by Korean Society of Spine Surgery
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 11 March 2015
                Date accepted : 13 March 2015
                Categories
                Subject: Clinical Study

                ScienceOpen disciplines: Orthopedics
                Keywords: glioma,intramedullary tumor,outcome,radiation therapy,spinal cord
                Data availability:
                ScienceOpen disciplines: Orthopedics
                Keywords: glioma, intramedullary tumor, outcome, radiation therapy, spinal cord

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