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Abstract

Spinal cord astrocytomas are rare neoplasms, and optimal treatment guidelines are undefined, 23 patients with spinal cord astrocytomas were treated between 1984 and 1993 with conservative surgery and postoperative radiotherapy. The mean age was 31 years. Twelve patients were male and eleven female. All patients presented with neurologic deficit. Cervical cord was involved in five patients, cervicothoracic in four, thoracic in eight and thoracolumbar in six. Five patients had intramedullary cysts. Fifteen patients had low grade tumors and six high grade. Surgery was near total excision in three patients, partial excision in ten and biopsy in ten patients. All patients received postoperative radiotherapy to a median dose of 45 Gy in 25 fractions over 5 weeks. The median followup was 51 months (range 7-143 months). At 6 months post radiotherapy, twelve patients had improvement of neurologic status, nine had stable status, and two deteriorated. The actuarial overall survival was 55% at 5 years and 39% at 10 years. The actuarial progression free survival probability was 75% at 5 years and 55% at 10 years. Five patients had local failure and two failed at distant sites. Twelve patients died, six due to progressive disease, five due to complications of paraplegia and one patient of unrelated causes. Tumor grade was a significant prognostic factor for overall survival. 5 year overall survival was 79% for low grade tumors. No patient with high grade tumor survived more than 2 years and the median survival was 10 months. Low grade, female sex and presence of intramedullary cysts were associated with significantly improved progression free survival. Conservative surgery followed by radiotherapy appears to have a role in achieving tumor control and neurologic recovery in patients with low grade astrocytomas of the spinal cord. Treatment results of high grade tumors remain poor and new therapeutic strategies need to be studied.

Prognostic factors in intramedullary astrocytomas: a literature review

“…Results of a statistical analysis of age as a prognostic factor were reported in 15 studies [2,5,24,27,28,30,34,41,46,49,56,59,60,64,65] (Table 4). Of these, 13 were classified as category A, 8 failed to find a significant relationship between age and prognosis [2,24,28,30,34,46,56,59], as did one additional category B study [27].…”

“…Of these, 13 were classified as category A, 8 failed to find a significant relationship between age and prognosis [2,24,28,30,34,46,56,59], as did one additional category B study [27]. Four category A studies reported increased age to negatively affect prognosis: Sandler et al [64] found patients with tumor recurrence to be older (mean 38 years, median 31 years) than those without recurrence (mean 19 years, median 17 years), furthermore the oldest three patients in his study all experienced recurrence within 1 year.…”

“…Of these, eight were classified as category A, five failed to identify significant relationship between history length and outcome [24,30,34,59,64], as did one additional category B study [22]. Three category A studies in agreement reported increased survival in patients with history length longer than 2 months [5] and 6 months [49,60].…”

“…Statistical analysis reporting functional status as a prognostic factor was reported in eight studies [24,27,30,34,41,46,56,59] (Table 7). All but one [27] were classified as category A, five did not report any significant relationship between functional status and survival [24,30,46,56,59].…”

“…Its use varies considerably; some centers use it as a standard part of treatment protocol [24,30,37], others irradiate patients according to the rapidity of preoperative disease progression [61] and other institutions irradiate patients depending upon resection extent [34,64].…”