Treatment of high-grade spinal cord astrocytoma of childhood with “8-in-1” chemotherapy and radiotherapy: a pilot study of CCG-945

Allen, Jeffrey C.; Aviner, Shraga; Yates, Allan J.; Boyett, James M.; Cherlow, Joel M.; Turski, Patrick A.; Epstein, Fred J.; Finlay, Jonathan L.

doi:10.3171/jns.1998.88.2.0215

Cited by 129 publications

(66 citation statements)

References 16 publications

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“…Chemotherapy has been used with some success in the treatment of children with high-grade spinal cord tumors. A 5-year progression-free survival of 46% was reported for 13 patients with high-grade spinal cord tumors treated with multiagent chemotherapy in addition to local therapy, suggesting a role for chemotherapy in the treatment of these patients [1]. …”

Section: Discussionmentioning

confidence: 99%

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High-Grade Pediatric Spinal Cord Tumors

Merchant¹,

Nguyen²,

Thompson

et al. 1999

Pediatr Neurosurg

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Our institutional experience with high-grade pediatric spinal cord tumors includes 11 children treated during the period of 1981-1997. All patients underwent a biopsy or an attempt at resection and received postoperative radiation therapy. Three patients had a gross-total resection of their primary tumor, 6 patients had a subtotal resection and the remaining 2 were biopsied. Histologically, these tumors were characterized as anaplastic astrocytoma (n = 6), glioblastoma multiforme (n = 3) or anaplastic oligodendroglioma (n = 2). Three patients were treated with craniospinal irradiation (38-48 Gy) in addition to a boost to the residual tumor. The median dose to the primary site for all patients was 48.6 Gy (range 38-55 Gy). The median overall survival was 13 months (range 8-149 months). Only 2 patients were alive at 138 and 149 months following radiation therapy. The median progression-free survival following radiation therapy was 10 months (range 2-80 months). There was no difference in progression-free or overall survival for those diagnosed with glioblastoma multiforme when compared to patients diagnosed with anaplastic astrocytoma or anaplastic oligodendroglioma. The pattern of failure was either diffuse or local. For the patients who failed diffusely (n = 6), the median progression-free survival was 2 months compared to 23 months for those whose failure was entirely local (p < 0.01). The median overall survival was significantly shorter for those who failed diffusely compared to those who failed locally (10 vs. 37 months, p < 0.01). High-grade spinal cord tumors in children have a poor prognosis based on this report. It is important to document the extent of disease accurately prior to the initiation of radiation therapy, since a subset of these patients progress rapidly outside of the field of irradiation.

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Section: Discussionmentioning

confidence: 99%

“…There are relatively few reported experiences describing the treatment of high-grade spinal cord tumors in the pediatric population [1, 2]. These tumors are rare and comprise less than 1% of central nervous system tumors seen in children and adolescents.…”

Section: Introductionmentioning

confidence: 99%

High-Grade Pediatric Spinal Cord Tumors

Merchant¹,

Nguyen²,

Thompson

et al. 1999

Pediatr Neurosurg

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“…There are few reports, and experience with chemotherapy in low-grade tumors is limited [24]. There is certainly a role for chemotherapy in high-grade tumor management [23], but it does not appear to provide a big survival benefit.…”

Section: Adjuvant Therapymentioning

confidence: 99%

“…New drugs used for chemotherapeutic management of central nervous system tumors have not been widely used to treat intramedullary tumors. Only the higher-grade glial tumors have been treated with a combination treatment which includes chemotherapy [23]. For the low-grade tumors little, if any, credible experience exists regarding the effect of medical treatment on these neoplasms [24].…”

Section: Introductionmentioning

confidence: 99%

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Neurosurgical Management of Intramedullary Spinal Cord Tumors in Children

Kothbauer

2007

Pediatr Neurosurg

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The majority of intramedullary spinal cord tumors in children are low-grade glial tumors. They become symptomatic with pain, neurologic deficits or spinal deformity. The diagnosis is most readily obtained using magnetic resonance imaging. The natural history is significant for slow progression of symptoms. Surgery is the best treatment and is also indicated to confirm the histological diagnosis. In case of a low-grade tumor or a vascular lesion such as hemangioblastoma or cavernoma, a total or near-total resection is attempted. For astrocytomas the resection almost always remains biologically incomplete, but a near-total resection is still associated with a long progression-free survival. Neurologic morbidity is relatively low during long-term follow-up but can be up to 30% for transient motor deficits. The risk for neurologic deterioration is higher for patients with pronounced dysfunction preoperatively. This is an important argument for early surgical resection. Surgery is performed using the spectrum of microsurgical techniques as well as advanced technology, e.g. lasers and intraoperative neurophysiological monitoring with motor evoked potentials. High-grade tumors are resected conservatively and treated with radiation and chemotherapy. The prognosis of high-grade glial tumors remains poor.

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