International Journal of Radiation Oncology*Biology*Physics
Clinical InvestigationPrognosis and Treatment of Spinal Cord Astrocytoma
Introduction
Intramedullary spinal cord astrocytomas are rare, representing only 6–8% of all spinal cord tumors. The small case numbers in published reviews have limited the conclusions that can be drawn regarding the efficacy of various treatments 1, 2, 3, 4. Controversy persists about the optimal extent of surgical resection and the need for postoperative radiotherapy (RT) 1, 3, 5, 6, 7, 8, 9. In the present study, we aimed to identify the prognostic factors for spinal cord astrocytoma and to determine the effects of surgery and RT on outcome in patients with astrocytic tumors of the spinal cord.
Section snippets
Methods and Materials
Our patient database was retrospectively searched for patients who had received a diagnosis of primary spinal cord astrocytoma between 1962 and 2005 at Mayo Clinic in Rochester, MN. The present study evaluated the clinical course of these patients. The Mayo Clinic institutional review board approved this study.
During the 43-year study period, no uniform approach existed regarding the preoperative diagnostic workup or postoperative treatment. Nonetheless, a detailed neurologic history and
Patient characteristics
A review of the patient database identified 136 consecutive patients who had primary spinal cord astrocytomas. Of the 136 patients, 120 had original histologic sections available for review, and the original pathologic diagnoses were accepted in the remaining 16 cases. Of the 136 patients, 69 had pilocytic tumors and 67 had infiltrative tumors (Table 1). The mean ± SD patient age at diagnosis was 34.7 ± 20.7 years, and 62% of the patients were male.
The mean ± SD number of involved vertebral
Discussion
Our results provide new information regarding patient characteristics, prognostic factors, and treatment outcomes for patients with astrocytic tumors of the spinal cord. The primary new findings are the survival benefit for irradiated infiltrative tumors, the lack of survival benefit for irradiated pilocytic tumors, and the worse outcome for patients with either type of tumor who underwent subtotal or gross total resection. The strengths of this study include its large sample size, central
Acknowledgments
We thank the Mayo Foundation Center for Translational Science Activities Service Center for statistical support. K. J. Minehan, B. W. Scheithauer, and M. P. Wright analyzed the data.
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Presented at the 2007 American Society for Therapeutic Radiology and Oncology 49th Annual Meeting, Los Angeles, CA, October 28 to November 1, 2007, and the 12th Annual Scientific Meeting of the Society of Neurooncology, Dallas, TX, November 15–18, 2007.
Conflict of interest: none.