Surgical treatment and neurological outcome of infiltrating intramedullary astrocytoma WHO II–IV: a multicenter retrospective case series

Abstract

Introduction Primary malignant spinal astrocytomas present rare oncological entities with limited median survival and rapid neurological deterioration. Evidence on surgical therapy, adjuvant treatment, and neurological outcome is sparse. We aim to describe the treatment algorithm and clinical features on patients with infiltrating intramedullary astrocytomas graded WHO II–IV. Methods The following is a multicentered retrospective study of patients treated for spinal malignant glioma WHO II–IV in five high-volume neurosurgical departments from 2008 to 2019. Pilocytic astrocytomas were excluded. We assessed data on surgical technique, perioperative neurological status, adjuvant oncological therapy, and clinical outcome. Results 40 patients were included (diffuse astrocytoma WHO II n = 11, anaplastic astrocytoma WHO III n = 12, WHO IV n = 17). Only 40% were functionally independent before surgery, most patients presented with moderate disability (47.5%). Most patients underwent a biopsy (n = 18, 45%) or subtotal tumor resection (n = 15, 37.5%), and 49% of the patients deteriorated after surgery. Patients with WHO III and IV tumors were treated with combined radiochemotherapy. Median overall survival (OS) was 46.5 months in WHO II, 25.7 months in WHO III, and 7.4 months in WHO IV astrocytomas. Preoperative clinical status and WHO significantly influenced the OS, and the extent of resection did not. Conclusion Infiltrating intramedullary astrocytomas WHO II–IV present rare entities with dismal prognosis. Due to the high incidence of surgery-related neurological impairment, the aim of the surgical approach should be limited to obtaining the histological tissue via a biopsy or, tumor debulking in cases with rapidly progressive severe preoperative deficits.

Genomic profiling and prognostic factors of H3 K27M‐mutant spinal cord diffuse glioma

“…These findings gradually challenged the current situation that the clinical management of spinal cord diffuse glioma is mainly referred to guidelines of their brain counterparts [ 25 , 26 , 27 ]. However, because of the low incidence and high risk of surgical resection of spinal cord diffuse glioma, controversial results have been reported in different spinal cord astrocytoma studies with small sample sizes [ 16 , 28 , 29 , 30 , 31 ], which cannot provide enough evidence for improving clinical management of spinal glioma. Thus, it is urgent to study the molecular and clinicopathological characteristics of spinal cord diffuse glioma in a large cohort to refine their diagnosis and clinical management.…”

Association Between the Extent of Resection and Prognosis in Adult Patients With WHO Grade III Gliomas: a Population-based Study

“…However, the associations in GTR were not observed in the infratentorial site and histologic type compared with N-GTR (both p for interaction <0.001). A possible explanation is that the aim of the surgical approach should be limited to infratentorial tumors due to the high incidence of surgery-related neurological impairment [31]. The bene t of maximal surgery may be attenuated in patients in AO or AOA-relevant subgroups because of the chemosensitivity of the histologic type [32].…”

Characterization and Treatment of Spinal Tumors

“…However, GTR of high grade SCAs may not always be feasible with reports citing the possibility of GTR in grade IV tumors at 0% and grade III tumors at 12% [ 52 ]. Butenschoen et al found that surgical resection did not correlate with OS in patients with infiltrating astrocytomas WHO II–IV [ 65 ]. The goal for surgery in patients with infiltrating SCA is to acquire histological tissue for biopsy or for tumor debulking in patients with preoperative deficits.…”