Clinical Investigation
Prognosis and Treatment of Spinal Cord Astrocytoma

https://doi.org/10.1016/j.ijrobp.2008.04.060Get rights and content

Purpose

To identify the prognostic factors for spinal cord astrocytoma and determine the effects of surgery and radiotherapy on outcome.

Methods and Materials

This retrospective study reviewed the cases of consecutive patients with spinal cord astrocytoma treated at Mayo Clinic Rochester between 1962 and 2005.

Results

A total of 136 consecutive patients were identified. Of these 136 patients, 69 had pilocytic and 67 had infiltrative astrocytoma. The median follow-up for living patients was 8.2 years (range, 0.08–37.6), and the median survival for deceased patients was 1.15 years (range, 0.01–39.9). The extent of surgery included incisional biopsy only (59%), subtotal resection (25%), and gross total resection (16%). Patients with pilocytic tumors survived significantly longer than those with infiltrative astrocytomas (median overall survival, 39.9 vs. 1.85 years; p < 0.001). Patients who underwent resection had a worse, although nonsignificant, median survival than those who underwent biopsy only (pilocytic, 18.1 vs. 39.9 years, p = 0.07; infiltrative, 19 vs. 30 months, p = 0.14). Postoperative radiotherapy, delivered in 75% of cases, gave no significant survival benefit for those with pilocytic tumors (39.9 vs. 18.1 years, p = 0.33) but did for those with infiltrative astrocytomas (24 vs. 3 months; Wilcoxon p = 0.006). On multivariate analysis, pilocytic histologic type, diagnosis after 1984, longer symptom duration, younger age, minimal surgical extent, and postoperative radiotherapy predicted better outcome.

Conclusion

The results of our study have shown that histologic type is the most important prognostic variable affecting the outcome of spinal cord astrocytomas. Surgical resection was associated with shorter survival and thus remains an unproven treatment. Postoperative radiotherapy significantly improved survival for patients with infiltrative astrocytomas but not for those with pilocytic tumors.

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.

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