TY - JOUR
T1 - Treatment, prognostic factors, and outcomes in spinal cord astrocytomas
AU - Fakhreddine, Mohamad H.
AU - Mahajan, Anita
AU - Penas-Prado, Marta
AU - Weinberg, Jeffrey
AU - McCutcheon, Ian E.
AU - Puduvalli, Vinay
AU - Brown, Paul D.
PY - 2013/4
Y1 - 2013/4
N2 - Background. Spinal astrocytomas are rare intramedullary CNS tumors for which there is limited consensus on treatment; the importance of the extent of resection (EOR), postoperative radiotherapy, and chemotherapy remains poorly understood. We report on outcomes associated with surgery, postoperative radiotherapy, and chemotherapy in a series of patients treated at M. D. Anderson Cancer Center (MDACC) with the aim of elucidating the role of these treatments in spinal astrocytomas. Methods. We retrospectively reviewed charts from a series of 83 patients with histologically confirmed spinal astrocytoma treated at MDACC during 1990- 2011. Data collected included patient demographic characteristics, prognostic indicators, and treatment modality at diagnosis. We analyzed overall survival (OS) and progression-free survival (PFS) for pilocytic (World Health Organization [WHO] grade I) and infiltrative (WHO grades II, III, and IV) astrocytomas, separately. Multivariate analysis was performed for the infiltrative patients but not the pilocytic patients because of a limited number of cases. Results. Higher WHO grade among all patients was associated with worse OS (P <.0001) and PFS (P = .0003). Among patients with infiltrative tumors, neither EOR nor radiotherapy was associated with a difference in outcomes in multivariate analysis; however, among patients with infiltrative astrocytomas, chemotherapy was significantly associated with improved PFS (hazard ratio = .22, P = .0075) but not OS (hazard ratio = .89, P = .83) in multivariate analysis. Conclusion. WHO grade was the strongest prognostic indicator in patients with spinal cord astrocytomas.
AB - Background. Spinal astrocytomas are rare intramedullary CNS tumors for which there is limited consensus on treatment; the importance of the extent of resection (EOR), postoperative radiotherapy, and chemotherapy remains poorly understood. We report on outcomes associated with surgery, postoperative radiotherapy, and chemotherapy in a series of patients treated at M. D. Anderson Cancer Center (MDACC) with the aim of elucidating the role of these treatments in spinal astrocytomas. Methods. We retrospectively reviewed charts from a series of 83 patients with histologically confirmed spinal astrocytoma treated at MDACC during 1990- 2011. Data collected included patient demographic characteristics, prognostic indicators, and treatment modality at diagnosis. We analyzed overall survival (OS) and progression-free survival (PFS) for pilocytic (World Health Organization [WHO] grade I) and infiltrative (WHO grades II, III, and IV) astrocytomas, separately. Multivariate analysis was performed for the infiltrative patients but not the pilocytic patients because of a limited number of cases. Results. Higher WHO grade among all patients was associated with worse OS (P <.0001) and PFS (P = .0003). Among patients with infiltrative tumors, neither EOR nor radiotherapy was associated with a difference in outcomes in multivariate analysis; however, among patients with infiltrative astrocytomas, chemotherapy was significantly associated with improved PFS (hazard ratio = .22, P = .0075) but not OS (hazard ratio = .89, P = .83) in multivariate analysis. Conclusion. WHO grade was the strongest prognostic indicator in patients with spinal cord astrocytomas.
KW - Chemotherapy
KW - Glioma
KW - Intramedullary
KW - Management prognosis
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U2 - 10.1093/neuonc/nos309
DO - 10.1093/neuonc/nos309
M3 - Review article
C2 - 23322747
AN - SCOPUS:84875697279
SN - 1522-8517
VL - 15
SP - 406
EP - 412
JO - Neuro-oncology
JF - Neuro-oncology
IS - 4
ER -