Management, outcomes, and prognostic factors of adult primary spinal cord gliomas

Haque, Waqar; Verma, Vivek; Barber, Sean M.; Tremont, Ivo; Butler, E. Brian; Teh, Bin S.

doi:10.1016/j.jocn.2020.12.015

Cited by 11 publications

(7 citation statements)

References 20 publications

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“…Similar to intracranial glioblastomas, primary spinal GBM has a poor prognosis with a mean survival of approximately 10-12 months [ 2 , 11 ]. Higher survival rates were reported in a National Cancer Database study (2004 to 2016) with a median OS of 23.9 months [ 12 ] and a case report by Nagarajan et al reporting a disease-free survival of 96 months [ 13 ]. While older age is an established poor prognostic factor for primary brain GBM, the prognostic role of age in primary spinal GBM is less clear due to mixed results in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…The radiation doses used in this series were 50 Gy and 59.4 Gy, consistent with doses reported in the literature ranging from 43.2 Gy to 65 Gy [ 2 , 13 ]. However, while there are studies describing the benefits of radiation therapy [ 6 , 11 , 17 ], other studies suggest that neither radiation therapy nor radiation dose is associated with survival [ 7 , 12 ]. Similarly, the use of more conformal techniques, such as VMAT, in this series did not confer better outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Two Cases of Primary Spinal Glioblastoma in Adults Treated With Multimodality Therapy

Cruz-Lim¹,

Germain²,

Sauciuc³

et al. 2022

Cureus

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Primary spinal glioblastoma (GBM) is a rare disease entity with no established standard treatment. We present two cases of primary spinal GBM initially presenting with motor-sensory deficits and back pain. Management varied in that the first patient received subtotal resection followed by radiation therapy, while the second patient underwent gross total resection followed by radiation therapy and temozolomide. The first patient died from hypoxemia secondary to disease progression affecting diaphragmatic motion three months after diagnosis. The second patient progressed intracranially and died 7.4 months after diagnosis. There is no standard of care for primary spinal GBM, so treatment should follow a multidisciplinary discussion focused on patient-specific goals. These cases highlight the poor prognosis of primary spinal GBM despite different treatment approaches, necessitating accurate reporting of all similar cases to help improve knowledge and management of this rare malignancy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Two Cases of Primary Spinal Glioblastoma in Adults Treated With Multimodality Therapy

Cruz-Lim¹,

Germain²,

Sauciuc³

et al. 2022

Cureus

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“…Although not implying causation, there is a trend towards improved overall survival with the use of chemotherapy and surgical resection for patients suffering from GB[ 21 ]. Despite the advancement in surgical techniques and postoperative adjuvant therapies, PSC GB still has an overall poor prognosis[ 9 , 21 ]. The overall survival in patients with PSC GB is approximately 10-14 mo[ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Atypical imaging features of the primary spinal cord glioblastoma: A case report

Li¹,

Chen²,

Li³

et al. 2022

WJCC

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BACKGROUND Primary spinal cord (PSC) glioblastoma (GB) is an extremely rare but fatal primary tumor of the central nervous system and associated with a poor prognosis. While typical tumor imaging features are generally easy to recognize, glioblastoma multiforme can have a wide range of imaging findings. Atypical GB is often misdiagnosed, which usually delays the optimal time for treatment. In this article, we discuss a clinical case of pathologically confirmed PSC GB under the guise of benign tumor imaging findings, as well as the most recent literature pertaining to PSC GB. CASE SUMMARY A 70-year-old female complained of limb weakness lasting more than 20 d. Irregular masses were observed inside and outside the left foramina of the spinal canal at C7-T1 on medical imaging. Based on the imaging features, radiologists diagnosed the patient with schwannoma. Tumor resection was performed under general anesthesia. The final histopathological findings revealed a final diagnosis of PSC GB, world health organization Grade IV. The patient subsequently underwent a 4-wk course of radiotherapy (60 Gy in 20 fractions) combined with temozolomide chemotherapy. The patient was alive at the time of submission of this manuscript. CONCLUSION Atypical GB presented unusual imaging findings, which led to misdiagnosis. Therefore, a complete recognition of imaging signs may facilitate early accurate diagnosis.

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“…of 135 patients with primary malignant intramedullary astrocytomas also established extent of resection as a significant predictor of survival ( 51 ). Resection can improve local control, delaying tumor progression and improving survival ( 52 ). A single-institutional study of 94 patients found that GTR was achieved in 13% of patients and a near-total resection achieved in another 34%.…”

Section: Managementmentioning

confidence: 99%

Surgical approaches to intramedullary spinal cord astrocytomas in the age of genomics

2022

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Intramedullary astrocytomas represent approximately 30%–40% of all intramedullary tumors and are the most common intramedullary tumor in children. Surgical resection is considered the mainstay of treatment in symptomatic patients with neurological deficits. Gross total resection (GTR) can be difficult to achieve as astrocytomas frequently present as diffuse lesions that infiltrate the cord. Therefore, GTR carries a substantial risk of new post-operative deficits. Consequently, subtotal resection and biopsy are often the only surgical options attempted. A midline or paramedian sulcal myelotomy is frequently used for surgical resection, although a dorsal root entry zone myelotomy can be used for lateral tumors. Intra-operative neuromonitoring using D-wave integrity, somatosensory, and motor evoked potentials is critical to facilitating a safe resection. Adjuvant radiation and chemotherapy, such as temozolomide, are often administered for high-grade recurrent or progressive lesions; however, consensus is lacking on their efficacy. Biopsied tumors can be analyzed for molecular markers that inform clinicians about the tumor’s prognosis and response to conventional as well as targeted therapeutic treatments. Stratification of intramedullary tumors is increasingly based on molecular features and mutational status. The landscape of genetic and epigenetic mutations in intramedullary astrocytomas is not equivalent to their intracranial counterparts, with important difference in frequency and type of mutations. Therefore, dedicated attention is needed to cohorts of patients with intramedullary tumors. Targeted therapeutic agents can be designed and administered to patients based on their mutational status, which may be used in coordination with traditional surgical resection to improve overall survival and functional status.

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Management, outcomes, and prognostic factors of adult primary spinal cord gliomas

Cited by 11 publications

References 20 publications

Two Cases of Primary Spinal Glioblastoma in Adults Treated With Multimodality Therapy

Two Cases of Primary Spinal Glioblastoma in Adults Treated With Multimodality Therapy

Atypical imaging features of the primary spinal cord glioblastoma: A case report

Surgical approaches to intramedullary spinal cord astrocytomas in the age of genomics

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