A Survey of 65 Tumors within the Spinal Cord: Surgical Results and the Importance of Preoperative Magnetic Resonance Imaging

Brotchi, Jacques; Dewitte, O.; Balériaux, Danielle; Vandesteene, Arlette; Raftopoulos, Christian; Flament-Durand, J; Noterman, J

doi:10.1227/00006123-199111000-00002

Cited by 110 publications

(60 citation statements)

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“…With these technological advances in mind, the clinical debate regarding appropriate treatment for spinal cord astrocytomas should be resumed. 14 In the present study, total and partial resections yielded better survival rates than biopsy alone in patients with spinal astrocytomas. Furthermore, a higher survival rate can be expected for cases with thoracic astrocytomas, compared to those with cervical astrocytomas.…”

Section: Discussionsupporting

confidence: 48%

“…Although we always attempted to perform total resection initially, it is not always possible to accomplish the procedure owing to the size, location, and nature of tumors. Because recent reports demonstrated that pilocytic astrocytomas can be totally resected, even if they look like high-grade malignancy tumors, 14 we should attempt at least partial, if possible total, resection of the tumor, especially for thoracic astrocytomas.…”

Section: Discussionmentioning

confidence: 99%

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Surgical outcomes of spinal cord astrocytomas

et al. 2006

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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.

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Section: Discussionsupporting

confidence: 48%

Section: Discussionmentioning

confidence: 99%

Surgical outcomes of spinal cord astrocytomas

et al. 2006

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“…Gross total resection (GTR) has been established as the gold standard in the treatment of intramedullary ependymoma, with series reporting 70-100% of ependymomas being radically resected [6,16,20,45,57] and long-term survival being the rule rather than exception. On the contrary, the therapeutical spectrum in infiltratively growing intramedullary astrocytomas ranges from histological verification and decompressive surgery with subsequent radiotherapy [64] to GTR, with 6-70% of intramedullary astrocytomas undergoing GTR [27,28,34,49,56,58,61,64].…”

Section: Introductionmentioning

confidence: 99%

Prognostic factors in intramedullary astrocytomas: a literature review

2009

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Astrocytomas affect a significant portion of patients with intramedullary tumors. These infiltratively growing tumors are treated by a variety of methods-biopsy and decompressive surgery, maximal safe resection, adjuvant oncological therapy. Also, numerous prognostic factors are reported in the literature. Better understanding of factors that influence prognosis may help in treatment planning with the goal of prolonging survival. We have thus undertaken an extensive literature review in order to define factors affecting prognosis. A total of 38 articles were studied. Only tumor grade was consistently reported as the major factor affecting prognosis. The influence of other clinical factors (age, gender, history length, functional status, tumor location or extent, syrinx or cyst presence) can be speculated upon, but cannot be assessed adequately from the available literature. For both low-and high-grade (HG) astrocytomas, maximal safe tumor resection should be the primary treatment objective but is often not feasible in contrast to other intramedullary and spinal neoplasms. Since the biological nature of spinal cord HG glioma is identical to that of the brain, the same treatment algorithm of maximal safe resection followed by concomitant radio-and chemotherapy would be sensible to implement.

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“…7,42,62 Maximal resection is generally agreed to be the cornerstone of treatment for pediatric spinal ependymomas; 2,7,8,34,42,47,50 however, the addition of adjuvant radiation therapy after surgery is the subject of more debate. 2,7,8,48 While there are many studies on spinal ependymomas in adults, 11,12,[16][17][18]21,24,25,38,41,45,51,56,57,61,65 there are few papers on these tumors in children, and those that do exist tend to be small, single-institution retrospective studies that are not powered for statistical analysis stratified by tumor grade. 2,8,13,22,27,42,47,53 The goal of this paper is to use the nationally representative Surveillance Epidemiology and End Results (SEER) database to offer a population-based perspective on pediatric Grade II spinal ependymomas.…”

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confidence: 99%

Treatment of pediatric Grade II spinal ependymomas: a population-based study

Lin

Jea

Melkonian

et al. 2015

PED

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OBJECT Grade II spinal cord ependymomas occurring in pediatric patients are exceptionally rare neoplasms. In this paper the authors use a national cancer database to determine patient demographics, treatment patterns, and associated outcomes of this cohort. METHODS The Surveillance Epidemiology and End Results (SEER) database was used to analyze subjects younger than 18 years with histologically confirmed diagnoses of Grade II spinal cord ependymoma from the years 1973 to 2008. Descriptive data on the demographic characteristics of this cohort and the associated treatment patterns are shown. The Kaplan-Meier method was used to estimate overall survival at 1, 2, 5, and 10 years. RESULTS This cohort comprised 64 pediatric subjects with Grade II spinal ependymoma. The median age was 13 years, nearly half of the patients were male, and most were white (84%). The median follow-up was 9.2 years. Overall survival at 5 and 10 years was 86% and 83%, respectively. Gross-total resection was achieved in 57% of subjects, and radiation therapy was administered to 36%. Radiation therapy was administered to 78% of subjects after subtotal resection but only to 19% of patients after gross-total resection; this difference was significant (p < 0.001). In a multivariate regression model analyzing sex, age at diagnosis, year of diagnosis, radiotherapy, and extent of resection, female sex was found to be an independent predictor of decreased mortality (HR 0.15 [95% CI 0.02–0.94], p = 0.04). CONCLUSIONS These data show long-term outcomes for pediatric patients with Grade II spinal ependymoma. Radiotherapy was more likely to be administered in cases of subtotal resection than in cases of gross-total resection. Female sex is associated with decreased mortality, while other demographic or treatment modalities are not.

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A Survey of 65 Tumors within the Spinal Cord: Surgical Results and the Importance of Preoperative Magnetic Resonance Imaging

Cited by 110 publications

References 0 publications

Surgical outcomes of spinal cord astrocytomas

Surgical outcomes of spinal cord astrocytomas

Prognostic factors in intramedullary astrocytomas: a literature review

Treatment of pediatric Grade II spinal ependymomas: a population-based study

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