Surgical outcomes of spinal cord astrocytomas

Abstract

Study design: Retrospective case series.Objectives: To analyze prognostic factors for patients with spinal cord astrocytomas. Setting: Department of Orthopaedic Surgery, Keio University, Japan. Methods: Seven patients received total excisions (group T), eight underwent partial excisions (group P), and 15 had excisional biopsies (group B). Impacts of the tumor histological grade, the level of the tumor, the types of surgical interventions, and the use of adjuvant radiotherapies on the survival and functional outcomes of 30 patients (18 in low-grade and 12 high-grade malignancy tumors) were analyzed. Results: The survival rate of the low-grade malignancy group was significantly higher than that of the high-grade group. The survival rate of the patients with thoracic astrocytomas was significantly higher than those with cervical astrocytomas. In both the low-and high-grade groups, the survival rates in groups P/T were significantly higher than those in group B. In the low-grade group, five patients, whose preoperative functional statuses were classified as 'fair' or better, remained 'fair' or better after surgery. In the high-grade group, the postoperative functional statuses were classified as 'no change' or 'aggravated' in all except two patients. No significant difference in the survival rates was detected between patients with and without adjuvant radiotherapy. Conclusions: The tumor grade and the extent of tumor resection were significant prognostic factors for survival rate. In low-grade malignancy group, good motor function was retained when surgeries were performed before substantial neurological deterioration. The efficacy of postoperative radiotherapy has yet to be determined and needs further study.

Prognostic factors in intramedullary astrocytomas: a literature review

“…Of these, five were classified as category A, four did not report any significant relationship between tumor location and outcome [24,28,30,34], only (8) 13 (100) 6 (46) (23) 39 (68) 10 (17) Minehan [49] found significantly ''increased'' survival in patients with thoracic spinal cord involvement. In addition, in one category B study, survival of patients with astrocytomas in thoracic location was significantly higher than in cervical location in both LG and HG tumors [51].…”

“…Remarkably, radical resection of anaplastic astrocytoma was not associated with increase in postoperative decline in neurological function [46]. In addition, one category B study reported increased 10-year OS in patients receiving GTR or PR when compared to biopsy (80 vs. 32%, p = 0.0251) [51].…”

“…Statistical analysis reporting tumor location as a prognostic factor was reported in nine studies [2,24,27,28,30,34,49,51,52] (Table 8). Of these, five were classified as category A, four did not report any significant relationship between tumor location and outcome [24,28,30,34], only (8) 13 (100) 6 (46) (23) 39 (68) 10 (17) Minehan [49] found significantly ''increased'' survival in patients with thoracic spinal cord involvement.…”

“…Only one category A study found significantly increased 10-year PFS for patients receiving GTR or STR when compared to partial resection (PR) defined as less than 80% tumor resection, although no such difference was found when comparing GTR with STR [9]. Also, one category B study reported significantly better 10-year OS in patients receiving GTR or PR when compared to biopsy only [51]. In addition, in the study of Epstein (category A), where all 17 patients received GTR, no recurrence was observed during a mean follow-up of 50 months [15].…”

“…Results for EOR specifically for HG histology were reported in nine studies, four were classified as category A [5,15,34,46], five as category B [11,27,51,52,65] (Table 13, lower part). Only one category A study reported increased 4-year OS in anaplastic astrocytoma (grade III) patients [46]; those receiving GTR had significantly improved survival (78% at 5 years) when compared to patients with STR (38% at 5 years, p = 0.028).…”