Intramedullary Astrocytoma – a Series of 15 Patients and Literature Overview

Česká verzia

Authors: V. Beneš lll ¹; O. Bradáč ²; S. Ostrý ²; P. Buchvald ¹; F. Kramář ²; M. Kaiser ¹; P. Suchomel ¹; V. Beneš Jr ²
Authors place of work: Neurochirurgické oddělení, Krajská nemocnice Liberec, a. s. ¹; Neurochirurgická klinika 1. LF UK, IPVZ a ÚVN Praha ²
Published in the journal: Cesk Slov Neurol N 2010; 73/106(2): 169-177
Category: Short Communication

Summary

Intramedullary astrocytoma is one of the less common tumours of the central nervous system. Certain ambiguities in the literature led us to make a retrospective review of a series of our own (2003–2009) and to compare the results with available literature. This series comprised 15 patients (10 women, 5 men), mean age 42.6 years. According to the McCormick scale, 5 patients were class I, 4 class II, 1 class III and 5 class IV. No tumour was radically resected, while 11 patients underwent subtotal resection, 4 only biopsy. Morbidity/mortality was 20% (1 dead and 2 patients deteriorating on the McCormick scale). Thirteen tumours were classified as low‑grade, 1 as grade III and one as glioblastoma. During the follow‑up period (mean 29.3 months) 5 patients died, 4 due to tumour progression. Median overall survival was estimated at 35.8 months. Younger age (p = 0.03), male sex (p = 0.04) and the presence of tumour cyst (p = 0.01) were identified as positive prognostic factors influencing overall survival. Other prognostic factors from the literature are discussed and treatment recommendations are made on the basis of its reviewing.

Key words:
intramedullary tumor – astrocytoma – survival – prognostic factors – literature review

Zdroje

1. Barker DJ, Weller RO, Garfield JS. Epidemiology of primary tumours of the brain and spinal cord: a regional survey in southern England. J Neurol Neurosurg Psychiatry 1976; 39(3): 290–296.

2. Helseth A, Mørk SJ. Primary intraspinal neoplasms in Norway, 1955 to 1986. A population‑based survey of 467 patients. J Neurosurg 1989; 71(6): 842–845.

3. Slooff JL, Kernohan JW, MacCarty CS. Primary intramedullary tumors of the spinal cord and filum terminale. Philadelphia‑London: WB Saunders Company 1964.

4. Stein BM, McCormick PC. Intramedullary neo-plasms and vascular malformations. Clin Neurosurg 1992; 39: 361–387.

5. Conway JE, Chou D, Clatterbuck RE, Brem H, Long DM, Rigamonti D. Hemangioblastomas of the central nervous system in von Hippel‑Lindau syndrome and sporadic disease. Neurosurgery 2001; 48(1): 55–62.

6. Costigan DA, Winkelman MD. Intramedullary spinal cord metastasis. A clinicopathological study of 13 cases. J Neurosurg 1985; 62(2): 227–233.

7. Hamburger C, Büttner A, Weis S. Ganglioglioma of the spinal cord: report of two rare cases and review of the literature. Neurosurgery 1997; 41(6): 1410–1415.

8. Hautzer NW, Aiyesimoju A, Robitaille Y. „Primary“ spinal intramedullary lymphomas: a review. Ann Neurol 1983; 14(1): 62–66.

9. Cohen AR, Wisoff JH, Allen JC, Epstein F. Malignant astrocytomas of the spinal cord. J Neurosurg 1989; 70(1): 50–54.

10. Johnson DL, Schwarz S. Intracranial metastases from malignant spinal‑cord astrocytoma. Case report. J Neurosurg 1987; 66(4): 621–625.

11. Santi M, Mena H, Wong K, Koeller K, Olsen C, Rushing EJ. Spinal cord malignant astrocytomas. Clinicopathologic features in 36 cases. Cancer 2003; 98(3): 554–561.

12. Brotchi J, Dewitte O, Levivier M, Balériaux D, Vandesteene A, Raftopoulos C et al. A survey of 65 tu-mors within the spinal cord: surgical results and the importance of preoperative magnetic resonance imaging. Neurosurgery 1991; 29(5): 651–656.

13. Epstein FJ, Farmer JP, Freed D. Adult intramedullary spinal cord ependymomas: the result of surgery in 38 patients. J Neurosurg 1993; 79(2): 204–209.

14. Guidetti B, Mercuri S, Vagnozzi R. Long‑term results of the surgical treatment of 129 intramedullary spinal gliomas. J Neurosurg 1981; 54(3): 323–330.

15. McCormick PC, Torres R, Post KD, Stein BM. Intramedullary ependymoma of the spinal cord. J Neurosurg 1990; 72(4): 523–532.

16. Raco A, Esposito V, Lenzi J, Piccirilli M, Delfini R, Cantore G. Long‑term follow‑up of intramedullary spinal cord tumors: a series of 202 cases. Neurosurgery 2005; 56(5): 972–981.

17. Innocenzi G, Salvati M, Cervoni L, Delfini R, Cantore G. Prognostic factors in intramedullary astrocytomas. Clin Neurol Neurosurg 1997; 99(1): 1–5.

18. Jallo GI, Danish S, Velasquez L, Epstein F. Intramedullary low‑grade astrocytomas: long‑term outcome following radical surgery. J Neurooncol 2001; 53(1): 61–66.

19. Kim MS, Chung CK, Choe G, Kim IH, Kim HJ. Intramedullary spinal cord astrocytoma in adults: postoperative outcome. J Neurooncol 2001; 52(1): 85–94.

20. Minehan KJ, Shaw EG, Scheithauer BW, Davis DL, Onofrio BM. Spinal cord astrocytoma: pathological and treatment considerations. J Neurosurg 1995; 83(4): 590–595.

21. Przybylski GJ, Albright AL, Martinez AJ. Spinalcord astrocytomas: long‑term results comparing treatments in children. Childs Nerv Syst 1997; 13(7): 375–382.

22. Reimer R, Onofrio BM. Astrocytomas of the spinal cord in children and adolescents. J Neurosurg 1985; 63(5): 669–675.

23. Rossitch E Jr, Zeidman SM, Burger PC, Curnes JT,Harsh C, Anscher M et al. Clinical and pathological analysis of spinal cord astrocytomas in children. Neurosurgery 1990; 27(2): 193–196.

24. Sandler HM, Papadopoulos SM, Thornton AF Jr, Ross DA. Spinal cord astrocytomas: results of therapy. Neurosurgery 1992; 30(4): 490–493.

25. Huddart R, Traish D, Ashley S, Moore A, Brada M.Management of spinal astrocytoma with conservative surgery and radiotherapy. Br J Neurosurg 1993; 7(5): 473–481.

26. Jyothirmayi R, Madhavan J, Nair MK, Rajan B. Conservative surgery and radiotherapy in the treatment of spinal cord astrocytoma. J Neurooncol 1997; 33(3): 205–211.

27. Kopelson G, Linggood RM. Intramedullary spinal cord astrocytoma versus glioblastoma: the prognostic importance of histologic grade. Cancer 1982; 50(4): 732–735.

28. Kleihues P, Cavenee WK. Pathology and genetics of tumours of the nervous system. Lyon: IARC Press 2000.

29. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958; 53: 457–481.

30. Minehan KJ, Brown PD, Scheithauer BW, Krauss WE, Wright MP. Prognosis and treatment of spinal cord astrocytoma. Int J Radiat Oncol Biol Phys 2009; 73(3): 727–733.

31. Abdel‑Wahab M, Etuk B, Palermo J, Shirato H, Kresl J, Yapicier O et al. Spinal cord gliomas: A multi‑institutional retrospective analysis. Int J Radiat Oncol Biol Phys 2006; 64(4): 1060–1071.

32. Bouffet E, Pierre‑Kahn A, Marchal JC, Jouvet A, Kalifa C, Choux M et al. Prognostic factors in pediatric spinal cord astrocytoma. Cancer 1998; 83(11): 2391–2399.

33. Constantini S, Miller DC, Allen JC, Rorke LB, Freed D,Epstein FJ. Radical excision of intramedullary spinal cord tumors: surgical morbidity and long‑term follow‑up evaluation in 164 children and young adults. J Neurosurg 2000; 93 (Suppl 2): 183–193.

34. Lee HK, Chang EL, Fuller GN, Aldape KD, Atkinson GJ, Levy LB et al. The prognostic value of neurologic function in astrocytic spinal cord glioma. Neuro Oncol 2003; 5(3): 208–213.

35. Rodrigues GB, Waldron JN, Wong CS, Laperriere NJ. A retrospective analysis of 52 cases of spinal cord glioma managed with radiation therapy. Int J Radiat Oncol Biol Phys 2000; 48(3): 837–842.

36. McGirt MJ, Goldstein IM, Chaichana KL, Tobias ME,Kothbauer KF, Jallo GI. Extent of surgical resection of malignant astrocytomas of the spinal cord: outcome analysis of 35 patients. Neurosurgery 2008; 63(1): 55–61.

37. Robinson CG, Prayson RA, Hahn JF, Kalfas IH, Whitfield MD, Lee SY et al. Long‑term survival and functional status of patients with low‑grade astrocytoma of spinal cord. Int J Radiat Oncol Biol Phys 2005; 63(1): 91–100.

38. Merchant TE, Nguyen D, Thompson SJ, Reardon DA, Kun LE, Sanford RA. High‑grade pediatric spinal cord tumors. Pediatr Neurosurg 1999; 30(1): 1–5.

39. O‘Sullivan C, Jenkin RD, Doherty MA, Hoffman HJ, Greenberg ML. Spinal cord tumors in children: long‑term results of combined surgical and radiation treatment. J Neurosurg 1994; 81(4): 507–512.

40. Epstein FJ, Farmer JP, Freed D. Adult intramedullary astrocytomas of the spinal cord. J Neurosurg 1992; 77(3): 355–359.

41. Nakamura M, Chiba K, Ishii K, Ogawa Y, Takaishi H, Matsumoto M et al. Surgical outcomes of spinal cord astrocytomas. Spinal Cord 2006; 44(12): 740–745.

42. Lambert PM. Radiation myelopathy of the thoracic spinal cord in long term survivors treated with radical radiotherapy using conventional fractionation. Cancer 1978; 41(5): 1751–1760.

43. Phillips TL, Buschke F. Radiation tolerance of the thoracic spinal cord. Am J Roentgenol Radium Ther Nucl Med 1969; 105(3): 659–664.

44. Nakamura M, Ishii K, Watanabe K, Tsuji T, Takaishi H, Matsumoto M et al. Surgical treatment of intramedullary spinal cord tumors: prognosis and complications. Spinal Cord 2008; 46(4): 282–286.

45. McLaughlin MP, Buatti JM, Marcus RB Jr, Maria BL, Mickle PJ, Kedar A. Outcome after radiotherapy of primary spinal cord glial tumors. Radiat Oncol Investig 1998; 6(6): 276–280.

46. Constantini S, Houten J, Miller DC, Freed D, Ozek MM, Rorke LB et al. Intramedullary spinal cord tumors in children under the age of 3 years. J Neurosurg 1996; 85(6): 1036–1043.

47. Cooper PR. Outcome after operative treatment of intramedullary spinal cord tumors in adults: intermediate and long‑term results in 51 patients. Neurosurgery 1989; 25(6): 855–859.

48. Cristante L, Herrmann HD. Surgical management of intramedullary spinal cord tumors: functional outcome and sources of morbidity. Neurosurgery 1994; 35(1): 69–74.

49. Hardison HH, Packer RJ, Rorke LB, Schut L, Sutton LN, Bruce DA. Outcome of children with primary intramedullary spinal cord tumors. Childs Nerv Syst 1987; 3(2): 89–92.

50. Hulshof MC, Menten J, Dito JJ, Dreissen JJ, van den Bergh R, González D. Treatment results in primary intraspinal gliomas. Radiother Oncol 1993; 29(3): 294–300.

51. Kopelson G, Linggood RM, Kleinman GM, Doucette J, Wang CC. Management of intramedullary spinal cord tumors. Radiology 1980; 135(2): 473–479.

52. Linstadt DE, Wara WM, Leibel SA, Gutin PH, Wilson CB, Sheline GE. Postoperative radiotherapy of primary spinal cord tumors. Int J Radiat Oncol Biol Phys 1989; 16(6): 1397–1403.

53. Garcia DM. Primary spinal cord tumors treated with surgery and postoperative irradiation. Int J Radiat Oncol Biol Phys 1985; 11(11): 1933–1939.

54. Shirato H, Kamada T, Hida K, Koyanagi I, Iwasaki Y,Miyasaka K et al. The role of radiotherapy in the management of spinal cord glioma. Int J Radiat Oncol Biol Phys 1995; 33(2): 323–328.

55. Innocenzi G, Raco A, Cantore G, Raimondi AJ. Intramedullary astrocytomas and ependymomas in the pediatric age group: a retrospective study. Childs Nerv Syst 1996; 12(12): 776–780.

56. Sanai N, Berger MS. Glioma extent of resection and its impact on patient outcome. Neurosurgery 2008; 62(4): 753–766.

57. Kothbauer K, Deletis V, Epstein FJ. Intraoperative spinal cord monitoring for intramedullary surgery: an essential adjunct. Pediatr Neurosurg 1997; 26(5): 247–254.

58. Zileli M, Coşkun E, Ozdamar N, Ovül I, Tunçbay E,Oner K et al. Surgery of intramedullary spinal cord tumors. Eur Spine J 1996; 5(4): 243–250.

59. Brotchi J, Dewitte O, Levivier M, Balériaux D, Vandesteene A, Raftopoulos C et al. A survey of 65 tumors within the spinal cord: surgical results and the importance of preoperative magnetic resonance imaging. Neurosurgery 1991; 29(5): 651–657.

60. Epstein F. Spinal cord astrocytomas of childhood. Adv Tech Stand Neurosurg 1986; 13: 135–169.

61. Epstein F, Epstein N. Surgical treatment of spinal cord astrocytomas of childhood. A series of 19 patients. J Neurosurg 1982; 57(5): 685–689.

62. Karim AB, Afra D, Cornu P, Bleehan N, Schraub S,De Witte O et al. Randomized trial on the efficacy of radiotherapy for cerebral low‑grade glioma in the adult: European Organization for Research and Treatment of Cancer Study 22845 with the Medical Research Council study BRO4: an interim analysis. Int J Radiat Oncol Biol Phys 2002; 52(2): 316–324.

63. van den Bent MJ, Afra D, de Witte O, Ben Hassel M, Schraub S, Hoang‑Xuan K et al. Long‑term efficacy of early versus delayed radiotherapy for low‑grade astrocytoma and oligodendroglioma in adults: the EORTC 22845 randomised trial. Lancet 2005; 366(9490): 985–990.

64. Kopelson G. Radiation tolerance of the spinal cord previously‑damaged by tumor and operation: long term neurological improvement and time‑dose‑volume relationships after irradiation of intraspinal gliomas. Int J Radiat Oncol Biol Phys 1982; 8(5): 925–929.

65. Marcus RB Jr, Million RR. The incidence of myelitis after irradiation of the cervical spinal cord. Int J Radiat Oncol Biol Phys 1990; 19(1): 3–8.

66. Wara WM, Phillips TL, Sheline GE, Schwade JG. Radiation tolerance of the spinal cord. Cancer 1975; 35(6): 1558–1562.

67. Allen JC, Aviner S, Yates AJ, Boyett JM, Cherlow JM, Turski PA et al. Treatment of high‑grade spinal cord astrocytoma of childhood with „8-in‑1“ chemotherapy and radiotherapy: a pilot study of CCG-945. Children‘s Cancer Group. J Neurosurg 1998; 88(2): 215–220.

68. Doireau V, Grill J, Zerah M, Lellouch‑Tubiana A, Couanet D, Chastagner P et al. Chemotherapy for unresectable and recurrent intramedullary glial tumours in children. Brain Tumours Subcommittee of the French Society of Paediatric Oncology (SFOP). Br J Cancer 1999; 81(5): 835–840.

69. Lowis SP, Pizer BL, Coakham H, Nelson RJ, Bouffet E.Chemotherapy for spinal cord astrocytoma: can natural history be modified? Childs Nerv Syst 1998; 14(7): 317–321.

70. Nishio S, Morioka T, Fujii K, Inamura T, Fukui M. Spinal cord gliomas: management and outcome with reference to adjuvant therapy. J Clin Neurosci 2000; 7(1): 20–23.

71. Weiss E, Klingebiel T, Kortmann RD, Hess CF, Bamberg M. Intraspinal high‑grade astrocytoma in a child-rationale for chemotherapy and more intensive radiotherapy? Childs Nerv Syst 1997; 13(2): 108–112.

72. Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 2005; 352(10): 987–996.