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Esparragosa Vazquez I, Ducray F. The Role of Radiotherapy, Chemotherapy, and Targeted Therapies in Adult Intramedullary Spinal Cord Tumors. Cancers (Basel) 2024; 16:2781. [PMID: 39199553 PMCID: PMC11353198 DOI: 10.3390/cancers16162781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 07/22/2024] [Accepted: 08/02/2024] [Indexed: 09/01/2024] Open
Abstract
Intramedullary primary spinal cord tumors are rare in adults and their classification has recently evolved. Their treatment most frequently relies on maximal safe surgical resection. Herein, we review, in light of the WHO 2021 classification of central nervous system tumors, the knowledge regarding the role of radiotherapy and systemic treatments in spinal ependymomas, spinal astrocytomas (pilocytic astrocytoma, diffuse astrocytoma, spinal glioblastoma IDH wildtype, diffuse midline glioma H3-K27M altered, and high-grade astrocytoma with piloid features), neuro-glial tumors (ganglioglioma and diffuse leptomeningeal glioneuronal tumor), and hemangioblastomas. In spinal ependymomas, radiotherapy is recommended for incompletely resected grade 2 tumors, grade 3 tumors, and recurrent tumors not amenable to re-surgery. Chemotherapy is used in recurrent cases. In spinal astrocytomas, radiotherapy is recommended for incompletely resected grade 2 astrocytomas and grade 3 or 4 tumors as well as recurrent tumors. Chemotherapy is indicated for newly diagnosed high-grade astrocytomas and recurrent cases. In hemangioblastomas not amenable to surgery, radiotherapy is an effective alternative option. Targeted therapies are playing an increasingly important role in the management of some intramedullary primary spinal cord tumor subtypes. BRAF and/or MEK inhibitors have demonstrated efficacy in pilocytic astrocytomas and glioneuronal tumors, belzutifan in von Hippel-Lindau-related hemangioblastomas, and promising results have been reported with ONC201 in diffuse midline glioma H3-K27M altered.
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Affiliation(s)
| | - François Ducray
- Neuro-Oncology Department, Hospices Civils of Lyon, 69500 Bron, France;
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Palpan Flores A, Rodríguez Domínguez V, Esteban Rodriguez I, Román de Aragón M, Zamarrón Pérez Á. H3K27M-mutant glioma in thoracic spinal cord and conus medullaris with pilocytic astrocytoma morphology: case report and review of the literature. Br J Neurosurg 2024; 38:1020-1026. [PMID: 34615413 DOI: 10.1080/02688697.2021.1988054] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 08/26/2021] [Accepted: 09/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The H3K27M-mutant spinal cord gliomas are very aggressive with a dismal prognosis, very few cases have been reported in the thoracic spinal cord and conus medullaris, and it is extremely rare with morphological features of pilocytic astrocytoma. CASE PRESENTATION A 20-year-old man presented with thoracolumbar pain, progressive paraparesis, and urinary incontinence. Magnetic resonance imaging revealed an intramedullary solid-cystic lesion from D9 to conus medullaris. Subtotal resection was performed, restricted by the indistinct margins and the decline of the motor evoked potential during the surgery. Pathologic findings revealed a pilocytic astrocytoma with anaplastic features. However, a further assessment determined a diffuse midline glioma H3K27M-mutant, and adjuvant chemoradiotherapy was administered. After seven months of progression-free survival, the paraparesis worsened; at twelve months of follow-up, the patient developed paraplegia, and at 24 months the patient remains alive without any neurologic functions distal to the tumor and he is still under adjuvant treatment. CONCLUSIONS The H3K27M-mutant spinal cord glioma is a very infrequent tumor with a wide variety of histological presentations even as indolent as pilocytic astrocytoma, which should be considered in spinal cord tumors, especially if there are clinical, histological, or radiological data that suggest aggressiveness. On the other hand, the fast progression led to the loss of complete neurological function distal to the tumor, in spinal tumors could explain a not so poor prognosis as it is in functionally and vital structures.
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Kumawat C, Takahashi T, Date I, Tomita Y, Tanaka M, Arataki S, Komatsubara T, Flores AOP, Yu D, Jain M. State-of-the-Art and New Treatment Approaches for Spinal Cord Tumors. Cancers (Basel) 2024; 16:2360. [PMID: 39001422 PMCID: PMC11240441 DOI: 10.3390/cancers16132360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/19/2024] [Accepted: 06/24/2024] [Indexed: 07/16/2024] Open
Abstract
Spinal cord tumors, though rare, present formidable challenges in clinical management due to their intricate nature. Traditional treatment modalities like surgery, radiation therapy, and chemotherapy have been the mainstay for managing these tumors. However, despite significant advancements, challenges persist, including the limitations of surgical resection and the potential side effects associated with radiation therapy. In response to these limitations, a wave of innovative approaches is reshaping the treatment landscape for spinal cord tumors. Advancements in gene therapy, immunotherapy, and targeted therapy are offering groundbreaking possibilities. Gene therapy holds the potential to modify the genes responsible for tumor growth, while immunotherapy harnesses the body's own immune system to fight cancer cells. Targeted therapy aims to strike a specific vulnerability within the tumor cells, offering a more precise and potentially less toxic approach. Additionally, novel surgical adjuncts are being explored to improve visualization and minimize damage to surrounding healthy tissue during tumor removal. These developments pave the way for a future of personalized medicine for spinal cord tumors. By delving deeper into the molecular makeup of individual tumors, doctors can tailor treatment strategies to target specific mutations and vulnerabilities. This personalized approach offers the potential for more effective interventions with fewer side effects, ultimately leading to improved patient outcomes and a better quality of life. This evolving landscape of spinal cord tumor management signifies the crucial integration of established and innovative strategies to create a brighter future for patients battling this complex condition.
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Affiliation(s)
- Chetan Kumawat
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan
- Department of Orthopedic Surgery, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi 110060, India
| | - Toshiyuki Takahashi
- Spinal Disorder Center, Fujieda Heisei Memorial Hospital, 123-1 Mizuue Fujieda, Shizuoka 426-8662, Japan
| | - Isao Date
- Department of Neurosurgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan
| | - Yousuke Tomita
- Department of Neurosurgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan
| | - Masato Tanaka
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan
| | - Shinya Arataki
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan
| | - Tadashi Komatsubara
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan
| | - Angel O P Flores
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan
| | - Dongwoo Yu
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan
| | - Mukul Jain
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward Okayama, Okayama 702-8055, Japan
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Wang Y, Mu Q, Sheng M, Chen Y, Jian F, Li R. A Nomogram for Predicting Overall Survival of Patients With Primary Spinal Cord Glioblastoma. Neurospine 2024; 21:676-689. [PMID: 38955537 PMCID: PMC11224756 DOI: 10.14245/ns.2448082.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/09/2024] [Accepted: 04/17/2024] [Indexed: 07/04/2024] Open
Abstract
OBJECTIVE Primary spinal cord glioblastoma (PSCGBM) is a rare malignancy with a poor prognosis. To date, no prognostic nomogram for this rare disease was established. Hence, we aimed to develop a nomogram to predict overall survival (OS) of PSCGBM. METHODS Clinical data of patients with PSCGBM was retrospectively collected from the neurosurgery department of Soochow University Affiliated Second Hospital and the Surveillance Epidemiology and End Results database. Information including age, sex, race, tumor extension, extent of resection, adjuvant treatment, marital status, income, year of diagnosis and months from diagnosis to treatment were recorded. Univariate and multivariate Cox regression analyses were used to identify independent prognostic factors for PSCGBM. A nomogram was constructed to predict 1-year, 1.5-year, and 2-year OS of PSCGBM. RESULTS A total of 132 patients were included. The 1-year, 1.5-year, and 2-year OS were 45.5%, 29.5%, and 18.9%, respectively. Four variables: age groups, tumor extension, extent of resection, and adjuvant therapy, were identified as independent prognostic factors. The nomogram showed robust discrimination with a C-index value for the prediction of 1-year OS, 1.5-year OS, and 2-year of 0.71 (95% confidence interval [CI], 0.61-0.70), 0.72 (95% CI, 0.62-0.70), and 0.70 (95% CI, 0.61-0.70), respectively. The calibration curves exhibited high consistencies between the predicted and observed survival probability in this cohort. CONCLUSION We have developed and internally validated a nomogram for predicting the survival outcome of PSCGBM for the first time. The nomogram has the potential to assist clinicians in making individualized predictions of survival outcome of PSCGBM.
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Affiliation(s)
- Yao Wang
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Qingchun Mu
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Minfeng Sheng
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Yanming Chen
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Fengzeng Jian
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Rujun Li
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
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Kayama R, Tsujino K, Kawabata S, Fujikawa Y, Kashiwagi H, Fukuo Y, Hiramatsu R, Takata T, Tanaka H, Suzuki M, Hu N, Miyatake SI, Takami T, Wanibuchi M. Translational research of boron neutron capture therapy for spinal cord gliomas using rat model. Sci Rep 2024; 14:8265. [PMID: 38594281 PMCID: PMC11003979 DOI: 10.1038/s41598-024-58728-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/02/2024] [Indexed: 04/11/2024] Open
Abstract
Boron neutron capture therapy (BNCT) is a type of targeted particle radiation therapy with potential applications at the cellular level. Spinal cord gliomas (SCGs) present a substantial challenge owing to their poor prognosis and the lack of effective postoperative treatments. This study evaluated the efficacy of BNCT in a rat SCGs model employing the Basso, Beattie, and Bresnahan (BBB) scale to assess postoperative locomotor activity. We confirmed the presence of adequate in vitro boron concentrations in F98 rat glioma and 9L rat gliosarcoma cells exposed to boronophenylalanine (BPA) and in vivo tumor boron concentration 2.5 h after intravenous BPA administration. In vivo neutron irradiation significantly enhanced survival in the BNCT group when compared with that in the untreated group, with a minimal BBB scale reduction in all sham-operated groups. These findings highlight the potential of BNCT as a promising treatment option for SCGs.
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Affiliation(s)
- Ryo Kayama
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki City, Osaka, Japan
| | - Kohei Tsujino
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki City, Osaka, Japan
| | - Shinji Kawabata
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki City, Osaka, Japan.
| | - Yoshiki Fujikawa
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki City, Osaka, Japan
| | - Hideki Kashiwagi
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki City, Osaka, Japan
| | - Yusuke Fukuo
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki City, Osaka, Japan
| | - Ryo Hiramatsu
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki City, Osaka, Japan
| | - Takashi Takata
- Institute for Integrated Radiation and Nuclear Science, Kyoto University, 2 Asashiro-Nishi, Kumatori-Cho, Sennan-Gun, Osaka, Japan
| | - Hiroki Tanaka
- Institute for Integrated Radiation and Nuclear Science, Kyoto University, 2 Asashiro-Nishi, Kumatori-Cho, Sennan-Gun, Osaka, Japan
| | - Minoru Suzuki
- Institute for Integrated Radiation and Nuclear Science, Kyoto University, 2 Asashiro-Nishi, Kumatori-Cho, Sennan-Gun, Osaka, Japan
| | - Naonori Hu
- Kansai BNCT Medical Center, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki City, Osaka, Japan
| | - Shin-Ichi Miyatake
- Kansai BNCT Medical Center, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki City, Osaka, Japan
| | - Toshihiro Takami
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki City, Osaka, Japan
| | - Masahiko Wanibuchi
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki City, Osaka, Japan
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Aashita A, Sharma R, Yadav V, Manikandan M, Dhameliya A, Mishra H, Thakur P, Malik A. Primary Intramedullary Spinal High-Grade Glioma: A Case Series with Review of Literature. South Asian J Cancer 2024; 13:150-156. [PMID: 38919654 PMCID: PMC11196153 DOI: 10.1055/s-0042-1758570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
AashitaBackground Primary intramedullary high-grade glioma (HGG) and glioblastoma of spinal cord are uncommon tumors of central nervous system. Treatment recommendations are based on current guidelines of intracranial HGG and glioblastoma multiforme (GBM). Methods We retrospectively analyzed records of 9,686 patients who reported to our center over past 7 years. Only three cases of primary intramedullary HGG of spinal cord were found. Results In this article, we have reported three cases of primary intramedullary HGG of spinal cord. A comparison of intracranial and intramedullary spinal HGG and review of literature is presented. Conclusion Despite aggressive treatment using surgery, radiation, and chemotherapy, the survival rates are dismal. Emerging evidence has shown difference in biological behavior of intracranial and spinal HGG. Genetic studies to understand the biology and prospective studies are needed.
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Affiliation(s)
- Aashita Aashita
- Department of Radiation Oncology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Rajiv Sharma
- Department of Radiation Oncology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Vikas Yadav
- Department of Radiation Oncology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Muthu Manikandan
- Department of Radiation Oncology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Ankit Dhameliya
- Department of Radiation Oncology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Hemendra Mishra
- Department of Radiation Oncology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Pragyat Thakur
- Department of Radiation Oncology, Homi Bhabha Cancer Hospital, Sangrur (Affiliated to HBNI, Mumbai), Maharashtra, India
| | - Abhidha Malik
- Department of Radiation Oncology, VMMC and Safdarjung Hospital, New Delhi, India
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Idu AA, Eva L, Covache-Busuioc RA, Glavan LA, Ciurea AV. Progressive Paraparesis and Spinal Glioblastoma in a Young Female. Cureus 2024; 16:e57593. [PMID: 38707088 PMCID: PMC11069329 DOI: 10.7759/cureus.57593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2024] [Indexed: 05/07/2024] Open
Abstract
Glioblastoma, a primary brain tumor known for its adverse prognosis and aggressive nature, presents a significant challenge when occurring in the spinal cord. We report a case of a 20-year-old female with no prior medical history who developed progressive paraparesis and urinary retention, symptoms indicative of an intramedullary glioblastoma in the spinal cord. This case study delves into the clinical presentation, diagnostic process, and therapeutic interventions, highlighting the complexities encountered during the patient's treatment course. Despite the typically poor prognosis associated with glioblastoma, with an average survival rate of approximately 15 months post-diagnosis, our patient's initial response to adjuvant chemotherapy and radiotherapy extended her survival to 34 months. However, tumor recurrence ultimately led to a decision against aggressive treatment, reflecting the challenges in managing this devastating condition. This case emphasizes the importance of a multidisciplinary approach in the care of spinal glioblastoma patients, ranging from neurosurgery, anesthesiology and intensive care, radiology, oncology, anatomic pathology and nuclear medicine, underscoring the complexity of the disease, while highlighting the urgent need for ongoing research and innovation in neuro-oncology to improve treatment outcomes. The use of modern treatment techniques, including the potential role of nanomaterials for drug delivery, suggests avenues for future research. This case report contributes to the scarce literature on spinal glioblastoma, advocating for detailed documentation of cases to enhance understanding and treatment strategies for this formidable disease.
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Affiliation(s)
- Andreea Anamaria Idu
- Department of Neurosurgery, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Lucian Eva
- Department of Neurosurgery, Nicolae Oblu Clinical Emergency Hospital, Iasi, ROU
| | | | - Luca-Andrei Glavan
- Department of Neurosurgery, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
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Snyder MH, Yu-Der Wang A, Ampie L, Sarathy D, Chatrath A, Asthagiri AR, Shaffrey CI, Smith JS, Shaffrey ME, Yen CP, Buchholz AL, Syed HR, Kryzanski J, Wu JK, Heilman CB. Primary Spinal Cord Astrocytomas: Two-Center Clinical Experience of Low- and High-Grade Lesions. World Neurosurg 2022; 167:e1006-e1016. [PMID: 36064118 DOI: 10.1016/j.wneu.2022.08.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 08/26/2022] [Accepted: 08/27/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Primary spinal cord astrocytomas are rare, fatal, and poorly studied. METHODS This study included a 2-center, retrospective analysis of primary spinal cord astrocytoma patients from 1997 to 2020. Patients with drop metastases or without at least one follow-up were excluded. RESULTS Seven World Health Organization grade I, 6 grade II, 7 grade III, and 4 grade IV astrocytoma patients were included. Older patients had higher grades (median 20 years in grade I vs. 36.5 in grade IV). The median follow-up was 15 months. Thirteen patients were discharged to rehabilitation. Eight patients demonstrated radiographic progression. Adjuvant therapy was utilized more in higher grades (5 of 13 grades III vs. all 11 grades IIIIV). Six patients died (1 death in grades III vs. 5 in grades IIIIV). Ten patients had worsened symptoms at the last follow-up. The median progression-free survival in grade I, II, III, and IV tumors was 116, 36, 8, and 8.5 months, respectively. The median overall survival in grade I, II, III, and IV tumors was 142, 69, 19, and 12 months, respectively. Thrombotic complications occurred in 2 patients, one with isocitrate dehydrogenasewild type glioblastoma. CONCLUSIONS Outcomes worsen with higher grades and lead to difficult postoperative periods. Clinicians should be vigilant for thromboembolic complications. Further research is needed to understand these rare tumors.
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Affiliation(s)
- M Harrison Snyder
- Department of Neurosurgery, University of Virginia Hospital, Charlottesville, VA, USA; Department of Neurosurgery, Tufts Medical Center, Boston, MA, USA.
| | - Andy Yu-Der Wang
- Department of Neurosurgery, Tufts Medical Center, Boston, MA, USA
| | - Leonel Ampie
- Department of Neurosurgery, University of Virginia Hospital, Charlottesville, VA, USA; Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
| | - Danyas Sarathy
- Department of Neurosurgery, University of Virginia Hospital, Charlottesville, VA, USA
| | - Ajay Chatrath
- Department of Neurosurgery, University of Virginia Hospital, Charlottesville, VA, USA
| | - Ashok R Asthagiri
- Department of Neurosurgery, University of Virginia Hospital, Charlottesville, VA, USA
| | | | - Justin S Smith
- Department of Neurosurgery, University of Virginia Hospital, Charlottesville, VA, USA
| | - Mark E Shaffrey
- Department of Neurosurgery, University of Virginia Hospital, Charlottesville, VA, USA
| | - Chun-Po Yen
- Department of Neurosurgery, University of Virginia Hospital, Charlottesville, VA, USA
| | - Avery L Buchholz
- Department of Neurosurgery, University of Virginia Hospital, Charlottesville, VA, USA
| | - Hasan R Syed
- Division of Neurosurgery, Children's National Hospital, Washington, DC, USA
| | - James Kryzanski
- Department of Neurosurgery, Tufts Medical Center, Boston, MA, USA
| | - Julian K Wu
- Department of Neurosurgery, Tufts Medical Center, Boston, MA, USA
| | - Carl B Heilman
- Department of Neurosurgery, Tufts Medical Center, Boston, MA, USA
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Yang S, Yang X, Wang H, Gu Y, Feng J, Qin X, Feng C, Li Y, Liu L, Fan G, Liao X, He S. Development and Validation of a Personalized Prognostic Prediction Model for Patients With Spinal Cord Astrocytoma. Front Med (Lausanne) 2022; 8:802471. [PMID: 35118095 PMCID: PMC8804494 DOI: 10.3389/fmed.2021.802471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/09/2021] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe study aimed to investigate the prognostic factors of spinal cord astrocytoma (SCA) and establish a nomogram prognostic model for the management of patients with SCA.MethodsPatients diagnosed with SCA between 1975 and 2016 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database and randomly divided into training and testing datasets (7:3). The primary outcomes of this study were overall survival (OS) and cancer-specific survival (CSS). Cox hazard proportional regression model was used to identify the prognostic factors of patients with SCA in the training dataset and feature importance was obtained. Based on the independent prognostic factors, nomograms were established for prognostic prediction. Calibration curves, concordance index (C-index), and time-dependent receiver operating characteristic (ROC) curves were used to evaluate the calibration and discrimination of the nomogram model, while Kaplan-Meier (KM) survival curves and decision curve analyses (DCA) were used to evaluate the clinical utility. Web-based online calculators were further developed to achieve clinical practicability.ResultsA total of 818 patients with SCA were included in this study, with an average age of 30.84 ± 21.97 years and an average follow-up time of 117.57 ± 113.51 months. Cox regression indicated that primary site surgery, age, insurance, histologic type, tumor extension, WHO grade, chemotherapy, and post-operation radiotherapy (PRT) were independent prognostic factors for OS. While primary site surgery, insurance, tumor extension, PRT, histologic type, WHO grade, and chemotherapy were independent prognostic factors for CSS. For OS prediction, the calibration curves in the training and testing dataset illustrated good calibration, with C-indexes of 0.783 and 0.769. The area under the curves (AUCs) of 5-year survival prediction were 0.82 and 0.843, while 10-year survival predictions were 0.849 and 0.881, for training and testing datasets, respectively. Moreover, the DCA demonstrated good clinical net benefit. The prediction performances of nomograms were verified to be superior to that of single indicators, and the prediction performance of nomograms for CSS is also excellent.ConclusionsNomograms for patients with SCA prognosis prediction demonstrated good calibration, discrimination, and clinical utility. This result might benefit clinical decision-making and patient management for SCA. Before further use, more extensive external validation is required for the established web-based online calculators.
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Affiliation(s)
- Sheng Yang
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
- Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, China
| | - Xun Yang
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Orthopedics, The First Affiliated Hospital, Shenzhen University, Shenzhen, China
- Shenzhen Second People's Hospital, Shenzhen, China
| | - Huiwen Wang
- Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuelin Gu
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Ministry of Education, Shanghai, China
- Institute of Science and Technology for Brain-Inspired Intelligence, Behavioral and Cognitive Neuroscience Center, Fudan University, Shanghai, China
| | - Jingjing Feng
- The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xianfeng Qin
- College of Artificial Intelligence, Guangxi University for Nationalities, Nanning, China
| | - Chaobo Feng
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
- Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, China
| | - Yufeng Li
- Department of Orthopedics, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Lijun Liu
- Department of Orthopedics, The First Affiliated Hospital, Shenzhen University, Shenzhen, China
- Shenzhen Second People's Hospital, Shenzhen, China
| | - Guoxin Fan
- National Key Clinical Pain Medicine of China, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
- Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Shenzhen University Health Science Center, Shenzhen, China
- Department of Pain Medicine, Shenzhen Municipal Key Laboratory for Pain Medicine, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
- *Correspondence: Guoxin Fan
| | - Xiang Liao
- National Key Clinical Pain Medicine of China, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
- Department of Pain Medicine, Shenzhen Municipal Key Laboratory for Pain Medicine, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
- Xiang Liao
| | - Shisheng He
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
- Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, China
- Shisheng He
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Helal A, Alvi M, Everson M, Mikula AL, Cohen Cohen S, Bydon M, Krauss WE, Clarke MJ. Prognostic Factors Independently Associated With Improved Progression-Free Survival After Surgical Resection in Patients With Spinal Cord Astrocytomas: An Institutional Case Series. Oper Neurosurg (Hagerstown) 2022; 22:106-114. [PMID: 35030157 DOI: 10.1227/ons.0000000000000084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 09/29/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Spinal astrocytomas are rare tumors in which the extent of resection and adjuvant therapy remain controversial. A number of new molecular markers are used, but their utility in spinal cord tumors remains unclear. OBJECTIVE To determine prognostic indicators of progression-free survival (PFS) in patients with spinal astrocytomas. METHODS A retrospective chart review identified all patients managed at a single institution for spinal cord astrocytomas between 1999 and 2019. Data collected included baseline demographics, presenting signs and symptoms, tumor size, operative outcomes, and adjuvant treatment. Pathological data including histopathological grade, proliferative index, and molecular profile were collected. Duration of follow-up, presence of tumor progression, and status at last follow-up were documented. Univariate and multivariate analyses were performed to determine predictors of PFS. RESULTS Seventy-five patients were included in our study with an average age of 42 ± 17 yr. The thoracic spine was the most commonly involved spinal segment (50 patients), and most patients had grade I or grade II tumors (50 patients). On univariate analysis, gross total resection (GTR), lower tumor grade, and low Ki-67 index were associated with lower tumor progression (P-values .01, .04, and .00013, respectively). On multivariate Cox regression analysis, GTR, adjuvant chemotherapy and radiation, and low Ki-67 index were independent predictors of PFS (P-values .009, .011, and .031, respectively). CONCLUSION In spinal astrocytomas, GTR, adjuvant therapy, and low Ki-67 are independently associated with improved PFS. These data may help guide management of these tumors and provide important prognosticating information.
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Affiliation(s)
- Ahmed Helal
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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11
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Upadhyay R, Khose S, Pokhylevych H, Paulino AC, McAleer MF, Ghia A, Li J, Yeboa DN, Loghin M, Harrison R, O’Brien B, Kamiya-Matsuoka C, De Groot J, Puduvalli VK, Tatsui C, Alvarez-Breckenridge C, Prabhu S, Rhines L, Zaky W, Lin F, Weinberg JS, Fuller G, Sandberg DI, Johnson JM, McGovern SL. Patterns of failure after radiation therapy in primary spinal high-grade gliomas: A single institutional analysis. Neurooncol Adv 2022; 4:vdac129. [PMID: 36128585 PMCID: PMC9476222 DOI: 10.1093/noajnl/vdac129] [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] [Indexed: 12/01/2022] Open
Abstract
Background Primary spinal high-grade gliomas (S-HGG) are rare aggressive tumors; radiation therapy (RT) often plays a dominant role in management. We conducted a single-institution retrospective review to study the clinicopathological features and management of S-HGGs. Methods Patients with biopsy-proven S-HGG who received RT from 2001 to 2020 were analyzed for patient, tumor, and treatment characteristics. Kaplan–Meier estimates were used for survival analyses. Results Twenty-nine patients were identified with a median age of 25.9 years (range 1–74 y). Four patients had GTR while 25 underwent subtotal resection or biopsy. All patients were IDH wildtype and MGMT-promoter unmethylated, where available. H3K27M mutation was present in 5 out of 10 patients tested, while one patient harbored p53 mutation. Median RT dose was 50.4 Gy (range 39.6–54 Gy) and 65% received concurrent chemotherapy, most commonly temozolomide. Twenty-three (79%) of patients had documented recurrence. Overall, 16 patients relapsed locally, 10 relapsed in the brain and 8 developed leptomeningeal disease; only 8 had isolated local relapse. Median OS from diagnosis was 21.3 months and median PFS was 9.7 months. On univariate analysis, age, gender, GTR, grade, RT modality, RT dose and concurrent chemotherapy did not predict for survival. Patients with H3K27M mutation had a poorer PFS compared to those without mutation (10.1 m vs 45.1 m) but the difference did not reach statistical significance (P = .26). Conclusions The prognosis of patients with spinal HGGs remains poor with two-thirds of the patients developing distant recurrence despite chemoradiation. Survival outcomes were similar in patients ≤ 29 years compared to adults > 29 years. A better understanding of the molecular drivers of spinal HGGs is needed to develop more effective treatment options.
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Affiliation(s)
- Rituraj Upadhyay
- Department of Radiation Oncology, The James Cancer Centre, Ohio State University , Columbus, Ohio , USA
| | - Swapnil Khose
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Halyna Pokhylevych
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Arnold C Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Mary Frances McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Amol Ghia
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Jing Li
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Debra Nana Yeboa
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Monica Loghin
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Rebecca Harrison
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Barbara O’Brien
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Carlos Kamiya-Matsuoka
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - John De Groot
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Vinay K Puduvalli
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Claudio Tatsui
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | | | - Sujit Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Larry Rhines
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Wafik Zaky
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Frank Lin
- Texas Children’s Cancer Center, Baylor College of Medicine , Houston, Texas , USA
| | - Jeffery S Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Gregory Fuller
- Department of Neuro-pathology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA (G.F.)
| | - David I Sandberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Jason Michael Johnson
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
| | - Susan L McGovern
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center , Houston, Texas , USA
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12
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Yuan C, Yao Q, Cheng L, Zhang C, Ma L, Guan J, Jian F. Prognostic factors and nomogram prediction of survival probability in primary spinal cord astrocytoma patients. J Neurosurg Spine 2021; 35:651-662. [PMID: 34388706 DOI: 10.3171/2021.1.spine202017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/26/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Knowledge on the management of spinal cord astrocytoma (SCA) remains scarce. Here, the authors constructed and validated a predictive nomogram, often used for individualized prognosis and evaluations, to estimate cancer-specific survival (CSS) and overall survival (OS) for patients with SCA. METHODS Epidemiological characteristics were compared between low-grade SCA (LGSCA) and high-grade SCA (HGSCA) patients from the Surveillance, Epidemiology, and End Results (SEER) database. Risk factors for CSS and OS were determined using univariate and multivariate analyses and Kaplan-Meier curves. A nomogram was developed to individually predict the 3-, 5-, and 10-year CSS and OS rates. The clinical usefulness of the nomogram was assessed using calibration plots, the concordance index (C-index), and time-dependent receiver operating characteristic curves. RESULTS A total of 468 LGSCA and 165 HGSCA patients were eligible for inclusion. LGSCA and HGSCA patients demonstrated differences in age, tumor extension, insurance status, adjuvant treatment, and survival. Multivariate analysis demonstrated that in the LGSCA group, tumor extension, surgery type, and adjuvant therapy were individually associated with CSS. The distance of tumor extension and WHO grade were individually associated with CSS in the HGSCA group. The prognostic variables were further demonstrated using the Kaplan-Meier method, which also suggested that adjuvant treatment provided no advantage to HGSCA patients. A nomogram was constructed, and the C-index for CSS was 0.84 by internal validation (95% CI 0.79-0.90). CONCLUSIONS This research suggests that the distance of tumor extension, type of surgery, and adjuvant therapy are significant risk factors for CSS using multivariate analysis in the LGSCA group. Adjuvant treatment provided no advantages for CSS or OS in patients with HGSCAs. The nomogram may be clinically useful to healthcare providers.
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Affiliation(s)
- Chenghua Yuan
- 1Department of Neurosurgery, Division of Spine, China International Neuroscience Institute (CHINA-INI), Xuanwu Hospital, Capital Medical University
- 2Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University; and
- 3Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qingyu Yao
- 1Department of Neurosurgery, Division of Spine, China International Neuroscience Institute (CHINA-INI), Xuanwu Hospital, Capital Medical University
- 2Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University; and
- 3Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lei Cheng
- 1Department of Neurosurgery, Division of Spine, China International Neuroscience Institute (CHINA-INI), Xuanwu Hospital, Capital Medical University
- 2Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University; and
- 3Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Can Zhang
- 1Department of Neurosurgery, Division of Spine, China International Neuroscience Institute (CHINA-INI), Xuanwu Hospital, Capital Medical University
- 2Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University; and
- 3Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Longbing Ma
- 1Department of Neurosurgery, Division of Spine, China International Neuroscience Institute (CHINA-INI), Xuanwu Hospital, Capital Medical University
- 2Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University; and
- 3Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jian Guan
- 1Department of Neurosurgery, Division of Spine, China International Neuroscience Institute (CHINA-INI), Xuanwu Hospital, Capital Medical University
- 2Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University; and
- 3Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Fengzeng Jian
- 1Department of Neurosurgery, Division of Spine, China International Neuroscience Institute (CHINA-INI), Xuanwu Hospital, Capital Medical University
- 2Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University; and
- 3Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
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13
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Sun P, Fan DJ, Fan T, Li X, Qi XL, Zhao XG, Gai QF. A Prospective Clinical Study on MGMT Protein Expression and the Effect of Gene Promoter Methylation on Sensitivity to Chemotherapeutics in Spinal Glioma. J Inflamm Res 2021; 14:4777-4784. [PMID: 34566423 PMCID: PMC8458026 DOI: 10.2147/jir.s321790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/28/2021] [Indexed: 11/23/2022] Open
Abstract
Objective The present study discusses the O6-methylguanine-DNA methyltransferase (MGMT) protein expression of spinal glioma cells and the correlation between the sensitivity of promoter methylation of the MGMT gene to chemotherapy drugs, establishes a prediction method for the sensitivity of chemotherapy drugs on spinal gliomas, providing a theoretical basis for determining the best chemotherapy regimens for clinical patients after a spinal glioma operation. Methods A total of 67 patients, who received microsurgical resection for spinal glioma from October 2010 to June 2016, were selected for the present study. Immunohistochemistry and methylation were performed after the operation. Among these patients, 47 patients with postoperative chemotherapy were assigned as the experimental group, while 20 patients without chemotherapy were designated as the control group. Results Among the 47 patients in the experimental group, 39 patients had no tumor recurrence after two years, while tumors increased and symptoms were aggravated in eight patients. The progression-free survival rate of chemotherapy was 82.9%, and the two-year survival rate was 100%. The adverse reactions of patients during chemotherapy were slight. Among the 20 patients in the control group, seven patients had no tumor recurrence, while 13 patients had increased tumor size, and the progression-free survival rate was 35.0%. Conclusion Under the guidance of MGMT immunohistochemical detection and MGMT gene promoter methylation detection after surgery, chemotherapy can effectively delay tumor recurrence, prevent a reoperation, and have good safety and tolerability. This chemotherapy regimen has good prospects.
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Affiliation(s)
- Peng Sun
- Baoding Second Hospital, Hebei, 071051, People's Republic of China
| | - Duo-Jiao Fan
- Baoding Second Hospital, Hebei, 071051, People's Republic of China
| | - Tao Fan
- Department of Neurosurgery Spine Center, Sanbo Brain Hospital, Capital Medical University, Beijing, 100093, People's Republic of China
| | - Xin Li
- Department of Neurosurgery, Baoding No. 1 Central Hospital, Hebei, 071051, People's Republic of China
| | - Xue-Ling Qi
- Department of Neurosurgery Spine Center, Sanbo Brain Hospital, Capital Medical University, Beijing, 100093, People's Republic of China
| | - Xin-Gang Zhao
- Department of Neurosurgery Spine Center, Sanbo Brain Hospital, Capital Medical University, Beijing, 100093, People's Republic of China
| | - Qi-Fei Gai
- Department of Neurosurgery Spine Center, Sanbo Brain Hospital, Capital Medical University, Beijing, 100093, People's Republic of China
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Jokovic M, Somma T, Ilic R, Guizzardi G, Stanimirovic A, Raicevic S, Milicevic M, Grujicic D, Solari D. Primary spinal glioblastoma multiforme. Single center experience and literature review. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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15
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Challenges in diagnosis and management of adult spinal cord gliomas. Rev Neurol (Paris) 2021; 177:515-523. [PMID: 33896651 DOI: 10.1016/j.neurol.2021.02.384] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 11/22/2022]
Abstract
Intramedullary spinal cord gliomas have very low incidence rates. They are associated with difficulties in diagnosis and treatment, and cause significant morbidity. Their clinical presentation and their appearance at magnetic resonance imaging are not specific. They can mimic inflammatory, infectious, vascular disorders or other neoplastic lesions. Primary treatment is surgery. Surgical resection can often be total for ependymomas, but difficult for infiltrating astrocytomas. Radiotherapy is indicated for malignant tumors, but remains controversial in some indications. Chemotherapy is reserved for recurrence, but small retrospective series are available. Genetic studies have revealed genetic alterations which could have a potential impact on treatment in the near future.
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16
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Gramatzki D, Felsberg J, Hentschel B, Bähr O, Westphal M, Schackert G, Tonn JC, Herrlinger U, Loeffler M, Pietsch T, Steinbach JP, Reifenberger G, Roth P, Weller M. Chemotherapy for adult patients with spinal cord gliomas. Neurooncol Pract 2021; 8:475-484. [PMID: 34277025 DOI: 10.1093/nop/npab017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The incidence of spinal cord gliomas, particularly in adults is low, and the role of chemotherapy has remained unclear. Methods We performed a multicenter, retrospective study of 21 patients diagnosed with spinal cord glioma who received chemotherapy at any time during the disease course. Benefit from chemotherapy was estimated by magnetic resonance imaging. Data on radiotherapy were taken into consideration. Results Thirteen patients were diagnosed with astrocytic gliomas World Health Organization (WHO) grades 1-4, the remaining eight patients with ependymomas WHO grades 1 or 3. Most patients had more than one neurosurgical intervention. Median age at time of first chemotherapy was 33 years (range 21-67 years). Seven patients had chemotherapy combined with radiotherapy as first-line treatment. Two patients had chemoradiotherapy at recurrence, without prior tumor-specific treatment beyond surgery. One patient received chemotherapy alone as first-line treatment and 2 patients had chemotherapy alone at recurrence, without prior treatment. Nine patients had received radiation therapy at an earlier time and chemotherapy was given at time of further recurrences. Best responses in astrocytomas were as follows: chemotherapy alone-2 stable disease (SD) and 3 progressive disease (PD); chemoradiotherapy-1 complete response, 3 SD, and 4 PD. Best responses in ependymomas were as follows: chemotherapy alone-1 partial response, 5 SD, and 1 PD; chemoradiotherapy-1 SD. Conclusions Spinal cord gliomas represent a heterogeneous group of tumors. Survival outcomes in response to chemotherapy in adult spinal cord glioma patients vary substantially, but individual patients appear to derive benefit from chemotherapy.
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Affiliation(s)
- Dorothee Gramatzki
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Jörg Felsberg
- Institute of Neuropathology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Bettina Hentschel
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Oliver Bähr
- Dr. Senckenberg Institute of Neurooncology, Goethe University Hospital, Frankfurt, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University of Hamburg, Hamburg, Germany
| | | | - Jörg Christian Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University Munich, Munich, Germany.,German Cancer Consortium, Partner Site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ulrich Herrlinger
- Department of Neurology, Division of Clinical Neurooncology, University Hospital Bonn, Bonn, Germany
| | - Markus Loeffler
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Torsten Pietsch
- Department of Neuropathology, DGNN Brain Tumor Reference Center, University Hospital Bonn, Bonn, Germany
| | | | - Guido Reifenberger
- Institute of Neuropathology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.,German Cancer Consortium, Partner Site Essen/Düsseldorf, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Patrick Roth
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Michael Weller
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
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ÜÇÜNCÜ KEFELİ A, HALİL S. Bevasizumab’a iyi cevap veren, Radyoterapi ve Temozolomid tedavisine yanıtsız bir Erişkin Spinal Kord Astrositomu; Olgu Sunumu ve Literatür Derlemesi. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2020. [DOI: 10.17517/ksutfd.767351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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18
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Zhang YW, Chai RC, Cao R, Jiang WJ, Liu WH, Xu YL, Yang J, Wang YZ, Jia WQ. Clinicopathological characteristics and survival of spinal cord astrocytomas. Cancer Med 2020; 9:6996-7006. [PMID: 32777166 PMCID: PMC7541164 DOI: 10.1002/cam4.3364] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/13/2020] [Accepted: 07/14/2020] [Indexed: 11/13/2022] Open
Abstract
Background Due to their rarity, the clinicopathological characteristics and prognostic factors of spinal cord gliomas are still unclear. Here, we aimed to clarify these issues in a cohort of 108 spinal cord astrocytomas. Methods We characterized the clinicopathological characteristics, including 2016 World Health Organization (WHO) grade, age, sex, location, segment length, resection, pre‐ and postsurgery, Modified McCormick Scale (MMS), radio‐ and chemotherapy, and Ki‐67 and H3 K27M mutations, in 108 spinal cord astrocytomas through heatmaps. The Cox regression analysis and Kaplan‐Meier curves were used to study the prognostic value of these clinicopathological features. Results There are a total 38 H3 K27M‐mutant tumors, including 31 cases with histological grade II/III tumors. The age of low‐grade astrocytoma patients (WHO grade I/II, n = 54) was significantly younger (27.0 vs 35.5 years, P = .001) than those with high‐grade tumors (WHO grade III/IV, n = 54). All patients underwent surgical resection with neurophysiological monitoring, and the surgery did not result in significant changes in MMS. The presurgery MMS was associated with overall survival in the high‐grade subgroup (P = .008) but not in the low‐grade subgroup (P = .312). While, the high content of resection improved the survival of only patients with low‐grade astrocytomas (P = .016) but not those with high‐grade astrocytomas (P = .475). Both the low‐grade and high‐grade astrocytomas had no obvious benefit from neither adjuvant chemotherapy nor radiotherapy (all P > .05). Conclusions We characterized the clinicopathological characteristics and their prognostic values in 108 spinal cord astrocytomas, which could help with evidence‐based management of spinal cord astrocytomas.
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Affiliation(s)
- Yao-Wu Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Rui-Chao Chai
- China National Clinical Research Center for Neurological Diseases, Beijing, China.,Department of Molecular Neuropathology, Beijing neurosurgical institute, Capital Medical University, Beijing, China.,Chinese Glioma Genome Atlas Network (CGGA), Beijing, China
| | - Ren Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Wen-Ju Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Wei-Hao Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yu-Lun Xu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jun Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yong-Zhi Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Department of Molecular Neuropathology, Beijing neurosurgical institute, Capital Medical University, Beijing, China.,Chinese Glioma Genome Atlas Network (CGGA), Beijing, China
| | - Wen-Qing Jia
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
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Yang K, Man W, Jing L, Sun Z, Liang P, Wang J, Wang G. Clinical Features and Outcomes of Primary Spinal Cord Glioblastoma: A Single-Center Experience and Literature Review. World Neurosurg 2020; 143:e157-e165. [PMID: 32688042 DOI: 10.1016/j.wneu.2020.07.066] [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: 04/28/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We aim to elucidate the clinical characteristics of patients with primary spinal cord glioblastoma (PSC GBM) and prognostic factors for their outcomes. METHODS A cohort of 11 patients with pathologically diagnosed PSC GBM from our center were retrospectively reviewed. The clinical, radiologic, operative, and molecular information were recorded, and univariate analysis was performed to identify prognostic factors. RESULTS The patient cohort included 5 males (45.5%) and 6 females (54.5%) with a median age of 26 years (range, 9-69 years). The median duration of the preoperative symptoms was 4.0 months (range, 0.5-120 months). Subtotal resection was achieved in 8 patients (72.7%) and partial resection in 3 (27.3%). Two patients (18.2%) underwent postoperative adjuvant chemoradiotherapy, 2 patients underwent (27.3%) chemotherapy only, and 6 patients (54.5%) neither. Two patients underwent additional therapy with bevacizumab. After a mean follow-up of 12.4 months (range, 1-33 months), Kaplan-Meier plot showed that the median progression-free survival and overall survival were 6.0 (range, 0.5-12.0) months and 12.0 (range, 1.0-33.0) months, respectively, and 1-year survival was 31.8%. Age at diagnosis and duration of the preoperative symptoms were confirmed as prognostic factors of progression-free survival and overall survival in univariate analysis (P < 0.05). CONCLUSIONS Despite aggressive treatment, PSC GBM still has a dismal prognosis and leads to severe neurologic deficit. Age at diagnosis and duration of the preoperative symptoms were confirmed as prognostic factors, yet the role of adjuvant radiochemotherapy and extent of resection are still unclear, necessitating further research.
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Affiliation(s)
- Kaiyuan Yang
- School of Clinical Medicine, Tsinghua University, Beijing, China; Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Weitao Man
- School of Clinical Medicine, Tsinghua University, Beijing, China; Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Linkai Jing
- School of Clinical Medicine, Tsinghua University, Beijing, China; Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Zhenxing Sun
- School of Clinical Medicine, Tsinghua University, Beijing, China; Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Ping Liang
- School of Clinical Medicine, Tsinghua University, Beijing, China; Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - James Wang
- School of Clinical Medicine, Tsinghua University, Beijing, China; Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Guihuai Wang
- School of Clinical Medicine, Tsinghua University, Beijing, China; Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
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20
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Predictors of mortality in patients with primary spinal cord glioblastoma. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:3203-3213. [PMID: 32594232 DOI: 10.1007/s00586-020-06515-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/09/2020] [Accepted: 06/18/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE Primary spinal cord glioblastoma (GBM) is a rare and devastating disease. Little attention was ever paid to this rare disease. As a result, the standard treatment protocol and prognostic factors of primary spinal cord GBM were not well established. The aim of this study was to determine the predictors associated with survival in patients with primary spinal cord GBM. METHODS A total of 122 patients with primary spinal cord GBM from Surveillance, Epidemiology, and End Results database and our institution were included in this retrospective analysis. Information about age, sex, race, tumor invasion, extent of resection, radiation, chemotherapy and year of diagnosis was collected. Univariate and multivariate accelerated failure time (AFT) regression model was performed to identify prognostic factors. RESULTS Of the 122 patients, 102 (83.6%) expired at the time of data collection. Overall survival at 1 year, 2 years, 3 years and 5 years was 48.4%, 22.8%, 17.1% and 8.4%, respectively, and median survival time was 12 months. Only radiation was found to be associated with survival in the AFT regression model (time ratio 1.94, 95% CI 1.01-3.72, p < 0.05). Radiotherapy could improve survival slightly; patients who received RT survived approximately two times as long as patients who did not receive RT, but the advantage was short term. CONCLUSION The survival of primary spinal cord GBM is poor in the current treatment strategy. Radiotherapy was associated with better survival, but the advantage was short term.
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Franceschi E, Frappaz D, Rudà R, Hau P, Preusser M, Houillier C, Lombardi G, Asioli S, Dehais C, Bielle F, Di Nunno V, van den Bent M, Brandes AA, Idbaih A. Rare Primary Central Nervous System Tumors in Adults: An Overview. Front Oncol 2020; 10:996. [PMID: 32676456 PMCID: PMC7333775 DOI: 10.3389/fonc.2020.00996] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/20/2020] [Indexed: 12/15/2022] Open
Abstract
Overall, tumors of primary central nervous system (CNS) are quite common in adults with an incidence rate close to 30 new cases/100,000 inhabitants per year. Significant clinical and biological advances have been accomplished in the most common adult primary CNS tumors (i.e., diffuse gliomas). However, most CNS tumor subtypes are rare with an incidence rate below the threshold defining rare disease of 6.0 new cases/100,000 inhabitants per year. Close to 150 entities of primary CNS tumors have now been identified by the novel integrated histomolecular classification published by the World Health Organization (WHO) and its updates by the c-IMPACT NOW consortium (the Consortium to Inform Molecular and Practical Approaches to CNS Tumor Taxonomy). While these entities can be better classified into smaller groups either by their histomolecular features and/or by their location, assessing their treatment by clinical trials and improving the survival of patients remain challenging. Despite these tumors are rare, research, and advances remain slower compared to diffuse gliomas for instance. In some cases (i.e., ependymoma, medulloblastoma) the understanding is high because single or few driver mutations have been defined. The European Union has launched European Reference Networks (ERNs) dedicated to support advances on the clinical side of rare diseases including rare cancers. The ERN for rare solid adult tumors is termed EURACAN. Within EURACAN, Domain 10 brings together the European patient advocacy groups (ePAGs) and physicians dedicated to improving outcomes in rare primary CNS tumors and also aims at supporting research, care and teaching in the field. In this review, we discuss the relevant biological and clinical characteristics, clinical management of patients, and research directions for the following types of rare primary CNS tumors: medulloblastoma, pineal region tumors, glioneuronal and rare glial tumors, ependymal tumors, grade III meningioma and mesenchymal tumors, primary central nervous system lymphoma, germ cell tumors, spinal cord tumors and rare pituitary tumors.
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Affiliation(s)
- Enrico Franceschi
- Department of Medical Oncology, Azienda USL/IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Didier Frappaz
- Department of Neuro-Oncology and Institut d'Hématologie et d'Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France
| | - Roberta Rudà
- Department of Neuro-Oncology, City of Health and Science and University of Turin, Turin, Italy
| | - Peter Hau
- Wilhelm Sander NeuroOncology-Unit, Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Matthias Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Caroline Houillier
- Sorbonne Université, IHU, ICM, Service de Neurologie 2-Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Giuseppe Lombardi
- Department of Oncology, Veneto Institute of Oncology-IRCCS, Padua, Italy
| | - Sofia Asioli
- Section of Anatomic Pathology "M. Malpighi", Department of Biomedical and Neuromotor Sciences, Bellaria Hospital, Bologna, Italy
| | - Caroline Dehais
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
| | - Franck Bielle
- Department of Neuropathology, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, AP-HP, Sorbonne Université, SIRIC Curamus, Paris, France
| | - Vincenzo Di Nunno
- Department of Medical Oncology, Azienda USL/IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Martin van den Bent
- The Brain Tumor Center at Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Alba A Brandes
- Department of Medical Oncology, Azienda USL/IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Ahmed Idbaih
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
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Adult primary high-grade spinal glioma: a nationwide analysis of current trends in treatment and outcomes. J Neurooncol 2020; 147:633-641. [PMID: 32185646 DOI: 10.1007/s11060-020-03458-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/11/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE High-grade spinal glioma (HGSG) is an extremely rare, malignant neoplasm insufficiently described in the literature. We sought to investigate the effect of epidemiological risk factors and treatment strategies on the prognosis of HGSGs using the National Cancer Database (NCDB). METHODS Patients with diagnosis codes specific for HGSG were queried from the NCDB during the years 2004-2016. Kaplan-Meier curves were generated with log-rank testing performed to assess factors affecting survival. Univariate and multivariate Cox regression analysis was also performed to investigate overall survival. RESULTS 396 patients were identified with a histologically-confirmed diagnosis of HGSG between 2004-2016. The mean survival time for all patients was 24.5 months (SD: 20.3). Multivariate Cox proportional-hazards regression analysis revealed that tumor size of 26-50 mm (HR 4.96, 95% CI 1.76-13.98, p < 0.01) and greater than 50 mm (HR 4.67, 95% CI 1.43-15.23, p = 0.01) were associated with worsened overall survival in comparison to lesions less than 26 mm. While quality of life was not investigated, both Kaplan-Meier log-rank testing and regression analysis failed to demonstrate an association of survival outcomes with extent of resection, radiotherapy, or chemotherapy. CONCLUSION The current study represents the largest retrospective analysis of adult primary high-grade spinal glioma to date. Our analysis found no relationship between the extent of surgical resection and survival outcomes. In addition, we failed to show any statistically significant survival benefit with radiotherapy or chemotherapy. This disease process has a poor prognosis without a current modality of treatment that improves survival.
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Delgado BJ, Moosavi L, Rangel E, Stull W, Polineni RD, Chen J, Cobos E. An Unusual Presentation of Spinal Giant Cell Glioblastoma in a 21-Year-Old Female. J Investig Med High Impact Case Rep 2019; 7:2324709619868255. [PMID: 31394931 PMCID: PMC6689908 DOI: 10.1177/2324709619868255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Primary spinal cord giant cell glioblastoma multiforme of the thoracic spinal cord is a rarely-diagnosed primary spinal cord tumor in comparison to neoplasms in intracranial locations. In this article, we highlight a young adult who was diagnosed with intramedullary giant cell glioblastoma, IDH wild-type, World Health Organization grade IV/IV of the thoracic spinal cord. This case report describes the treatment approach with a postsurgical combination of radiation therapy and temozolomide, which resulted in the patient to return to her baseline of health only to later develop neurological symptoms significant for a recurrence of malignancy. In a review of the literature of described cases of primary spinal cord glioblastoma multiforme, prognosis continues to be unfavorable as current treatment options of the aggressive malignancy remain absent of a cure.
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Affiliation(s)
| | - Leila Moosavi
- 2 Kern Medical-University of California Los Angeles, Bakersfield, CA, USA
| | | | - William Stull
- 2 Kern Medical-University of California Los Angeles, Bakersfield, CA, USA
| | - Rahul Dev Polineni
- 2 Kern Medical-University of California Los Angeles, Bakersfield, CA, USA
| | - Joseph Chen
- 2 Kern Medical-University of California Los Angeles, Bakersfield, CA, USA
| | - Everardo Cobos
- 2 Kern Medical-University of California Los Angeles, Bakersfield, CA, USA
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Azad TD, Jiang B, Bettegowda C. Molecular foundations of primary spinal tumors-implications for surgical management. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:222. [PMID: 31297387 DOI: 10.21037/atm.2019.04.46] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Primary spinal tumors are rare lesions that require careful clinical management due to their intimate relationship with critical neurovascular structures and the significant associated risk of morbidity. While the advent of molecular and genomic profiling is beginning to impact the management of the cranial counterparts, translation for spinal tumors has lagged behind. Maximal safe surgical resection remains the mainstay of patients with primary spinal tumors, with extent of resection and histology the only consistently identified independent predictors of survival. Adjuvant therapy has had limited impact. To develop targeted neoadjuvant and adjuvant therapies, improve prognostication, and enhance patient selection in spinal oncology, a thorough understanding of the current molecular and genomic landscape of spinal tumors is required. In this review, we detail the epidemiology, current standard-of-care, and molecular features of the most commonly encountered intramedullary spinal cord tumors (IMSCT), intradural extramedullary (IDEM) tumors, and primary spinal column malignancies (PSCM). We further discuss current efforts and future opportunities for integrating molecular advances in spinal oncology with clinical management.
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Affiliation(s)
- Tej D Azad
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Bowen Jiang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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25
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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: 36] [Impact Index Per Article: 7.2] [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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27
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Teng YD, Abd-El-Barr M, Wang L, Hajiali H, Wu L, Zafonte RD. Spinal cord astrocytomas: progresses in experimental and clinical investigations for developing recovery neurobiology-based novel therapies. Exp Neurol 2018; 311:135-147. [PMID: 30243796 DOI: 10.1016/j.expneurol.2018.09.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/07/2018] [Accepted: 09/16/2018] [Indexed: 12/25/2022]
Abstract
Spinal cord astrocytomas (SCAs) have discernibly unique signatures in regards to epidemiology, clinical oncological features, genetic markers, pathophysiology, and research and therapeutic challenges. Overall, there are presently very limited clinical management options for high grade SCAs despite progresses made in validating key molecular markers and standardizing tumor classification. The endeavors were aimed to improve diagnosis, therapy design and prognosis assessment, as well as to define more effective oncolytic targets. Efficacious treatment for high grade SCAs still remains an unmet medical demand. This review is therefore focused on research state updates that have been made upon analyzing clinical characteristics, diagnostic classification, genetic and molecular features, tumor initiation cell biology, and current management options for SCAs. Particular emphasis was given to basic and translational research endeavors targeting SCAs, including establishment of experimental models, exploration of unique profiles of SCA stem cell-like tumor survival cells, characterization of special requirements for effective therapeutic delivery into the spinal cord, and development of donor stem cell-based gene-directed enzyme prodrug therapy. We concluded that precise understanding of molecular oncology, tumor survival mechanisms (e.g., drug resistance, metastasis, and cancer stem cells/tumor survival cells), and principles of Recovery Neurobiology can help to create clinically meaningful experimental models of SCAs. Establishment of such systems will expedite the discovery of efficacious therapies that not only kill tumor cells but simultaneously preserve and improve residual neural function.
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Affiliation(s)
- Yang D Teng
- Departments of Physical Medicine & Rehabilitation and Neurosurgery, Harvard Medical School, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Division of Spinal Cord Injury Research, VA Boston Healthcare System, Boston, MA, USA.
| | - Muhammad Abd-El-Barr
- Departments of Physical Medicine & Rehabilitation and Neurosurgery, Harvard Medical School, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Division of Spinal Cord Injury Research, VA Boston Healthcare System, Boston, MA, USA; Current affiliation: Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
| | - Lei Wang
- Departments of Physical Medicine & Rehabilitation and Neurosurgery, Harvard Medical School, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Division of Spinal Cord Injury Research, VA Boston Healthcare System, Boston, MA, USA
| | - Hadi Hajiali
- Departments of Physical Medicine & Rehabilitation and Neurosurgery, Harvard Medical School, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Division of Spinal Cord Injury Research, VA Boston Healthcare System, Boston, MA, USA
| | - Liqun Wu
- Departments of Physical Medicine & Rehabilitation and Neurosurgery, Harvard Medical School, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Division of Spinal Cord Injury Research, VA Boston Healthcare System, Boston, MA, USA
| | - Ross D Zafonte
- Departments of Physical Medicine & Rehabilitation and Neurosurgery, Harvard Medical School, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Division of Spinal Cord Injury Research, VA Boston Healthcare System, Boston, MA, USA
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28
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Campello C, Parker F, Slimani S, Le Floch A, Herbrecht A, Aghakhani N, Lacroix C, Loiseau H, Lejeune J, Perrin G, Honnorat J, Dufour H, Chinot O, Figarella D, Bauchet L, Duffau H, Lonjon M, Labauge P, Messerer M, Daures J, Fabbro P, Ducot B. Tumeurs gliales intramédullaires de l’adulte : la série du rapport. Neurochirurgie 2017; 63:381-390. [DOI: 10.1016/j.neuchi.2016.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 09/18/2016] [Accepted: 10/23/2016] [Indexed: 10/19/2022]
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Nunn A, Polyzoidis S, Piechowski-Jozwiak B, Brazil L, Ashkan K. Primary glioblastoma multiforme of the conus medullaris with leptomeningeal metastasis. J Neurol Sci 2017; 381:315-317. [DOI: 10.1016/j.jns.2017.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 09/01/2017] [Accepted: 09/04/2017] [Indexed: 12/27/2022]
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Chaskis E, Minichini V, Luce S, Devriendt D, Goldman S, De Witte O, Sadeghi N, Lefranc F. [Contribution of temozolomide chemotherapy for intramedullary grade II spinal cord astrocytomas in adults: Our experience]. Neurochirurgie 2017; 63:297-301. [PMID: 28882604 DOI: 10.1016/j.neuchi.2017.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 05/08/2017] [Accepted: 05/20/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Grade II intramedullary astrocytomas are rare tumors. Despite a well-defined role of adjuvant temozolomide chemotherapy for brain gliomas, the contribution of this therapy for intramedullary gliomas is not yet clearly defined. METHOD We retrospectively analyzed the data of 5 adult patients treated with temozolomide between 2008 and 2015 for a grade II intramedullary astrocytoma with progression after surgery. RESULTS Five patients from 19 to 70 years of age (median, 37years) underwent a second surgery for the progression of a grade II intramedullary astrocytoma (median progression-free survival 26months [8-90]). All tumors remained grade II. Due to a second clinical or/and radiological tumor progression, the patients were treated with temozolomide after a 37months median progression-free survival (5-66). All patients received at minimum 12 cycles (mean 14 ± 5; range 12-24) of temozolomide (150-200mg/m2/day, 5days/28days). All patients were alive after a 10-year median follow-up after diagnosis (6-13). All patients were able to walk except one, who was previously in McCormick autonomy grade IV before chemotherapy. The McCormick autonomy rating after temozolomide was stable for 4 patients and improved for 1 patient. The treatment was delayed once for hematological toxicity. CONCLUSION Temozolomide stabilized all 5 patients without any major toxicity. Based on this experience that needs to be confirmed, we consider that temozolomide should be envisaged within the therapeutic arsenal for progressive intramedullary grade II astrocytomas.
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Affiliation(s)
- E Chaskis
- Services de neurochirurgie, hôpital Erasme, route de Lennik, 808, 1070 Bruxelles, Belgique
| | - V Minichini
- Services de neurochirurgie, hôpital Erasme, route de Lennik, 808, 1070 Bruxelles, Belgique
| | - S Luce
- Services d'oncologie médicale, hôpital Erasme, route de Lennik, 808, 1070 Bruxelles, Belgique
| | - D Devriendt
- Service de radiothérapie, institut Jules-Bordet, université libre de Bruxelles, 1000 Bruxelles, Belgique
| | - S Goldman
- Service de médecine nucléaire, hôpital Erasme, route de Lennik, 808, 1070 Bruxelles, Belgique
| | - O De Witte
- Services de neurochirurgie, hôpital Erasme, route de Lennik, 808, 1070 Bruxelles, Belgique
| | - N Sadeghi
- Service de radiologie, clinique de neurochirurgie oncologique, hôpital Erasme, route de Lennik, 808, 1070 Bruxelles, Belgique
| | - F Lefranc
- Services de neurochirurgie, hôpital Erasme, route de Lennik, 808, 1070 Bruxelles, Belgique.
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Prasad GL. Primary Spinal Cord Glioblastoma Multiforme: A Rare but Uniformly Fatal Neoplasm. World Neurosurg 2017; 104:1020-1021. [DOI: 10.1016/j.wneu.2017.02.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 02/27/2017] [Indexed: 10/19/2022]
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32
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Cheng X, Lou S, Huang S, Chen H, Liu J. Primary Spinal Cord Glioblastoma Multiforme: A Retrospective Study of Patients at a Single Institution. World Neurosurg 2017; 106:113-119. [PMID: 28377242 DOI: 10.1016/j.wneu.2017.03.120] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 03/24/2017] [Accepted: 03/25/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Primary spinal cord (PSC) glioblastoma multiforme (GBM) is extremely rare and accounts for only 1.5% of all spinal cord tumors. Therefore, its treatment is still ill defined. To elucidate prognostic factors, we performed a single-institutional retrospective review of the largest series to date of patients with PSC GBM who underwent surgical resection in West China Hospital between 2008 and 2014. A total of 14 patients with PSC GBM were reviewed. METHODS Demographic, operative, and postoperative factors were recorded. Overall survival (OS) and progression-free survival (PFS) were calculated and compared with the Kaplan-Meier method. RESULTS Eight males (57%) and 6 females (43%) were involved in the study. Their median age was 28 years (range, 14-56 years). Median Karnofsky Performance Status score was 60 (range, 20-90). Four patients (28.6%) received gross total resection, 5 (35.7%) partial resection, and the remaining 5 (35.7%) biopsy only. Nine patients (64.3%) received postoperative radiotherapy and chemotherapy, 3 (21.4%) chemotherapy only, and 2 (14.3%) neither. Median follow-up period was 15 months (range, 5-26 months). One-year and 2-year survival was 78.5% (11/14) and 7.1% (1/14), respectively. Median OS was 15 months, and median PFS 8 months. Univariate log-rank analysis showed that OS and PFS were significantly associated with patients' age (P = 0.007 and P = 0.04, respectively) and postoperative radiotherapy (P = 0.001 and P = 0.002, respectively). However, preoperative Karnofsky Performance Status score affected only OS and did not affect PFS (P = 0.033 and P = 0.106, respectively). CONCLUSIONS According to our study, the combination of postoperative radiotherapy and temozolomide chemotherapy can improve prognosis and may serve as a feasible postoperative adjuvant treatment of PSC GBM.
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Affiliation(s)
- Xing Cheng
- Department of Neurosurgery, Chongqing Cancer Hospital, Chongqing, China; Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Silong Lou
- Department of Neurosurgery, Chongqing Cancer Hospital, Chongqing, China
| | - Siqing Huang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Haifeng Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jiagang Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
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Shen CX, Wu JF, Zhao W, Cai ZW, Cai RZ, Chen CM. Primary spinal glioblastoma multiforme: A case report and review of the literature. Medicine (Baltimore) 2017; 96:e6634. [PMID: 28422860 PMCID: PMC5406076 DOI: 10.1097/md.0000000000006634] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RATIONALE Primary spinal glioblastoma multiforme (GBM) is a rare clinical entity with an aggressive course and an invariably dismal prognosis. Its clinical characteristics, radiologic and pathologic findings, and treatment protocols have been discussed in a few cases. PATIENT CONCERNS A 15-year-old female was admitted to the neurology department with a chief complaint of progressive numbness and weakness in her left upper extremity for 3 months and neck pain for 1 month. DIAGNOSES Spinal magnetic resonance imaging showed an intramedullary expansile mass localized between C4 and C7. The diagnosis of GBM was determined on the basis of the histopathological findings after operation. INTERVENTIONS Laminotomy and laminoplasty between C4 and C7 were performed, and the tumor was partially resected. The patient was administered focal adjuvant radiotherapy concomitantly with oral chemotherapy following the surgery. OUTCOMES With severe neurologic deficits at 13 months after the diagnosis, the patient expired. LESSONS Although therapeutic options have been improving, the prognosis of the primary spinal GBM remains poor. The treatment of primary spinal GBM entered into a central registry and multiple-center cooperation is important in establishing future therapeutic strategies.
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Yan C, Kong X, Yin H, Wang Y, He H, Zhang H, Gao J, Li Y, Ma W. Glioblastoma multiforme in conus medullaris with intracranial metastasis after postoperative adjuvant therapy. Medicine (Baltimore) 2017; 96:e6500. [PMID: 28353599 PMCID: PMC5380283 DOI: 10.1097/md.0000000000006500] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 03/06/2017] [Accepted: 03/07/2017] [Indexed: 11/26/2022] Open
Abstract
Spinal glioblastoma multiforme is not common among spinal cord tumors. According to our literature review, only 27 cases originating from the conus medullaris were reported. We herein reported a case of a 10-year-old child diagnosed with glioblastoma multiforme. The patient received adjuvant radiotherapy and standard temozolomide chemotherapy after total excision. Intracranial lesions were found 1 month after postoperative adjuvant therapy. We described the clinical characteristics and postoperative therapy of the patient, and reviewed all of the published cases of conus medullaris glioblastoma. Location, age, leptomeningeal spread, and secondary hydrocephalus may be predictive factors. Immunohistochemical factors such as p53 and Ki-67 are also important. Combined treatment of surgery and postoperative adjuvant therapy is commonly used, but is controversial.
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Affiliation(s)
- Chengrui Yan
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, P.R. China
| | - Xiangyi Kong
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, P.R. China
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Harvard University, MA
| | - Hua Yin
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, P.R. China
| | - Yu Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, P.R. China
| | - Huayu He
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, P.R. China
| | - Hui Zhang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, P.R. China
| | - Jun Gao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, P.R. China
| | - Yongning Li
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, P.R. China
| | - Wenbin Ma
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, P.R. China
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Behmanesh B, Setzer M, Konczalla J, Harter P, Quick-Weller J, Imoehl L, Franz K, Gessler F, Seifert V, Marquardt G. Management of Patients with Primary Intramedullary Spinal Cord Glioblastoma. World Neurosurg 2017; 98:198-202. [DOI: 10.1016/j.wneu.2016.10.075] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 10/12/2016] [Accepted: 10/14/2016] [Indexed: 11/26/2022]
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Infiltrating spinal cord astrocytomas: Epidemiology, diagnosis, treatments and future directions. J Clin Neurosci 2016; 29:15-20. [DOI: 10.1016/j.jocn.2015.10.048] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 10/14/2015] [Accepted: 10/25/2015] [Indexed: 11/17/2022]
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Yanamadala V, Koffie RM, Shankar GM, Kumar JI, Buchlak QD, Puthenpura V, Frosch MP, Gudewicz TM, Borges LF, Shin JH. Spinal cord glioblastoma: 25years of experience from a single institution. J Clin Neurosci 2016; 27:138-41. [DOI: 10.1016/j.jocn.2015.11.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 11/21/2015] [Indexed: 10/22/2022]
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Primary spinal cord glioblastoma multiforme treated with temozolomide. J Clin Neurosci 2015; 22:1877-82. [DOI: 10.1016/j.jocn.2015.04.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 03/30/2015] [Accepted: 04/05/2015] [Indexed: 11/22/2022]
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Radiotherapy of spinal cord gliomas : A retrospective mono-institutional analysis. Strahlenther Onkol 2015; 192:139-45. [PMID: 26519080 DOI: 10.1007/s00066-015-0917-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 10/07/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Due to the rarity of spinal cord gliomas, no consensus has been reached regarding the optimal treatment strategy. The aim of the present retrospective study was to identify patient and tumor characteristics and to evaluate the effectiveness of radiotherapy within this setting. PATIENTS AND METHODS Patients diagnosed with spinal cord gliomas between 2003 and 2013 and treated at the Department of Radiation Oncology, University of Munich, were retrospectively analyzed. Overall survival was estimated with the Kaplan-Meier method and univariate analysis was performed by log-rank testing. RESULTS A total of 16 patients were identified. The cohort consisted of seven primary spinal cord gliomas and eight cases of metastases of cerebral gliomas. Median follow-up was 42 months and median total radiation dose was 45.0 Gy. In all, 62.5 % of patients received a simultaneous chemotherapy with temozolomide. The median overall survival was 6 months (95% CI: 0-27.5 months). Surgical resection of the tumor was a significant predictor of improved survival, compared with radiotherapy alone (p = 0.001). Patients with the diagnosis of a primary spinal cord glioma survived significantly longer than those presenting with a metastatic deposit from a cerebral glioma (p < 0.001). A statistically significant dose-response relationship at dose levels of ≥ 45 Gy vs. < 45 Gy could be derived (p < 0.001). Simultaneous chemotherapy did not influence survival outcome. CONCLUSION Despite the aggressive treatment in the present study, the prognosis for spinal cord gliomas was still poor, with a median overall survival of 6 months. To the best of our knowledge, this is the largest study reporting the results of simultaneous chemoradiation in spinal cord gliomas. A combined chemoradiation treatment seems feasible and can be considered as a new treatment option in the management of spinal cord gliomas.
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Varghese SS, Sebastian P, Joseph V, Chacko G, Backianathan S. An unusually long survival of a patient with glioblastoma of spinal cord: a case report. J Clin Diagn Res 2014; 8:QD01-3. [PMID: 24959488 DOI: 10.7860/jcdr/2014/8486.4218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 02/16/2014] [Indexed: 11/24/2022]
Abstract
Primary glioblastoma of spinal cord are rare and are associated with poor survival especially in adults. We report a case of glioblastoma of thoracic spinal cord (D3 to D6) in an adult treated with partial resection surgery and radiation therapy with a survival of six years with good quality of life. The patient had paraplegia at presentation but improved after surgery and radiation therapy to grade 4 in both lower limbs. After 5 years, he developed new lesion in a different location of the spine (L1, L2 & L5) along with multiple lesions over entire spine and was treated with radiation therapy and a year later developed a new lesion intracranially in the posterior fossa involving cerebellopontine angle region infiltrating brainstem. He was treated with palliative radiotherapy and is on chemotherapy with Temozolomide and is still alive with ability to do activities of daily living at the time of this report. Radiation therapy provided prolonged local control with effective palliation of symptoms and good quality of life in this patient enabling to do activities of daily living.
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Affiliation(s)
- Sunitha Susan Varghese
- Assistant Professor, Department of Radiation Oncology, Christian Medical College , Vellore, India
| | - Patricia Sebastian
- Assistant Professor, Department of Radiation Oncology, Christian Medical College , Vellore, India
| | - Vivek Joseph
- Professor, Neurosurgery, Department of Neurological Sciences, Christian Medical College , Vellore, India
| | - Geeta Chacko
- Professor, Neuropathology, Departments of Pathology and Neurological Sciences, Christian Medical College , Vellore, India
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Abstract
Tumours of the spinal cord, although rare, are associated with high morbidity. Surgical resection remains the primary treatment for patients with this disease, and offers the best chance for cure. Such surgical procedures, however, carry substantial risks such as worsening of neurological deficit, paralysis and death. New therapeutic avenues for spinal cord tumours are needed, but genetic studies of the molecular mechanisms governing tumourigenesis in the spinal cord are limited by the scarcity of high-quality human tumour samples. Many spinal cord tumours have intracranial counterparts that have been extensively studied, but emerging data show that the tumours are genetically and biologically distinct. The differences between brain and spine tumours make extrapolation of data from one to the other difficult. In this Review, we describe the demographics, genetics and current treatment approaches for the most commonly encountered spinal cord tumours--namely, ependymomas, astrocytomas, haemangioblastomas and meningiomas. We highlight advances in understanding of the biological basis of these lesions, and explain how the latest progress in genetics and beyond are being translated to improve patient care.
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