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Title: Spinal cord gliomas: A multi-institutional retrospective analysis

Abstract

Purpose: To determine the impact of postoperative radiation therapy (POXRT) on outcome in spinal cord gliomas. Patients and Methods: Data from 242 patients were collected retrospectively from six institutions using a standardized data sheet. Pathology specimens, when available, were centrally reviewed. Results: A total of 183 patients were analyzed: 82 received surgery alone as initial treatment, whereas 101 had surgery and POXRT. Demographic, diagnostic, and treatment factors were analyzed for impact on progression-free (PFS) and overall survival (OS). PFS in ependymoma patients was 74%, 60%, and 35% at 5, 10, 15 years, respectively, and was significantly influenced by treatment type, race, age, tumor grade, and type of surgery on univariate analysis, with age being the only significant factor on multivariate analysis (MVA) (p = 0.01). OS of ependymoma patients was 91%, 84%, and 75% at 5, 10, and 15 years, respectively, and was significantly influenced by both complete resection (p = 0.04) and age (p = 0.03) on MVA. In astrocytomas, PFS was 42%, 29%, and 15% at 5, 10, and 15 years, and was significantly influenced by POXRT in low- and intermediate-grade tumors on MVA (p = 0.02). OS at 5, 10, and 15 years was 59%, 53%, andmore » 32%, respectively, and was significantly influenced by grade on MVA (p < 0.01). Conclusion: Postoperative radiation therapy reduced disease progression in low- and moderate-grade astrocytomas. In ependymomas, complete resection significantly influenced OS.« less

Authors:
 [1];  [2];  [3];  [4];  [5];  [6];  [7];  [8];  [3];  [9];  [10];  [5];  [2]
  1. Department of Radiation Oncology, University of Miami, Miami, FL (United States). E-mail: mwahab@med.miami.edu
  2. Department of Radiation Oncology, University of Miami, Miami, FL (United States)
  3. Department of Radiation Oncology, Wake Forest University School of Medicine, Wake Forest, NC (United States)
  4. Department of Radiation Oncology, Hokkaido University, Hokkaido (Japan)
  5. Department of Radiation Oncology, Arizona Oncology Services at St Joseph's Hospital and Medical Center, and Cyberknife Center, Barrow Neurologic Institute, Phoenix, AZ (United States)
  6. Department of Pathology, Anadolu Health Care System, Kocaeli (Turkey)
  7. University of Miami/Sylvester Comprehensive Cancer Center, Division of Biostatistics, Miami, FL (United States)
  8. Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN (United States)
  9. Department of Radiation Oncology, Wayne State University, Detroit, MI (United States)
  10. Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA (United States)
Publication Date:
OSTI Identifier:
20793384
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 64; Journal Issue: 4; Other Information: DOI: 10.1016/j.ijrobp.2005.09.038; PII: S0360-3016(05)02708-2; Copyright (c) 2006 Elsevier Science B.V., Amsterdam, Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ASTROCYTOMAS; MULTIVARIATE ANALYSIS; PATHOLOGY; PATIENTS; RADIOTHERAPY; SPINAL CORD; SURGERY

Citation Formats

Abdel-Wahab, May, Etuk, Blessing, Palermo, James, Shirato, Hiroki, Kresl, John, Yapicier, Ozlem, Walker, Gail, Scheithauer, Bernd W., Shaw, Edward, Lee, Charles, Curran, Walter, Thomas, Terry, and Markoe, Arnold. Spinal cord gliomas: A multi-institutional retrospective analysis. United States: N. p., 2006. Web. doi:10.1016/J.IJROBP.2005.0.
Abdel-Wahab, May, Etuk, Blessing, Palermo, James, Shirato, Hiroki, Kresl, John, Yapicier, Ozlem, Walker, Gail, Scheithauer, Bernd W., Shaw, Edward, Lee, Charles, Curran, Walter, Thomas, Terry, & Markoe, Arnold. Spinal cord gliomas: A multi-institutional retrospective analysis. United States. doi:10.1016/J.IJROBP.2005.0.
Abdel-Wahab, May, Etuk, Blessing, Palermo, James, Shirato, Hiroki, Kresl, John, Yapicier, Ozlem, Walker, Gail, Scheithauer, Bernd W., Shaw, Edward, Lee, Charles, Curran, Walter, Thomas, Terry, and Markoe, Arnold. Wed . "Spinal cord gliomas: A multi-institutional retrospective analysis". United States. doi:10.1016/J.IJROBP.2005.0.
@article{osti_20793384,
title = {Spinal cord gliomas: A multi-institutional retrospective analysis},
author = {Abdel-Wahab, May and Etuk, Blessing and Palermo, James and Shirato, Hiroki and Kresl, John and Yapicier, Ozlem and Walker, Gail and Scheithauer, Bernd W. and Shaw, Edward and Lee, Charles and Curran, Walter and Thomas, Terry and Markoe, Arnold},
abstractNote = {Purpose: To determine the impact of postoperative radiation therapy (POXRT) on outcome in spinal cord gliomas. Patients and Methods: Data from 242 patients were collected retrospectively from six institutions using a standardized data sheet. Pathology specimens, when available, were centrally reviewed. Results: A total of 183 patients were analyzed: 82 received surgery alone as initial treatment, whereas 101 had surgery and POXRT. Demographic, diagnostic, and treatment factors were analyzed for impact on progression-free (PFS) and overall survival (OS). PFS in ependymoma patients was 74%, 60%, and 35% at 5, 10, 15 years, respectively, and was significantly influenced by treatment type, race, age, tumor grade, and type of surgery on univariate analysis, with age being the only significant factor on multivariate analysis (MVA) (p = 0.01). OS of ependymoma patients was 91%, 84%, and 75% at 5, 10, and 15 years, respectively, and was significantly influenced by both complete resection (p = 0.04) and age (p = 0.03) on MVA. In astrocytomas, PFS was 42%, 29%, and 15% at 5, 10, and 15 years, and was significantly influenced by POXRT in low- and intermediate-grade tumors on MVA (p = 0.02). OS at 5, 10, and 15 years was 59%, 53%, and 32%, respectively, and was significantly influenced by grade on MVA (p < 0.01). Conclusion: Postoperative radiation therapy reduced disease progression in low- and moderate-grade astrocytomas. In ependymomas, complete resection significantly influenced OS.},
doi = {10.1016/J.IJROBP.2005.0},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 4,
volume = 64,
place = {United States},
year = {Wed Mar 15 00:00:00 EST 2006},
month = {Wed Mar 15 00:00:00 EST 2006}
}
  • Of 26 patients with intramedullary spinal cord gliomas (9 astrocytomas, 5 glioblastomas, 12 ependymomas) seen at the Massachusetts General Hospital from 1962-1980, 24 were irradiated (21 initially and 3 after post-surgical recurrence). Those 19 patients who survived at least 1 year after completion of irradiation were evaluated for post-irradiation neurological changes.No patient developed radiation myelopathy. Return to a permanently and completely normal neurological status occured for 33/51 (65%) of pre-irradiation neurological deficits. The major cause of post-irradiation neurological deterioration was tumor recurrence. Although 18/19 patients had their thoracic or lumbar spinal cords irradiated, each with field sizes greater than 10more » cm, spinal cord doses approaching, equalling, or occasionally exceeding various definitions of spinal cord tolerance were tolerated well without evidence of radiation myelopathy. Spinal cords of patients with intramedullary gliomas, often with major neurological deficits prior to irradiation, may be treated safely to doses approaching or equalling spinal cord tolerance levels. These doses are expected to locally control most ependymomas and astrocytomas without an increased radiation myelopathy. Caution should be observed if doses higher than this are contemplated in an attempt to cure glioblastoma, because the 5% tolerance level of the damaged spinal remains to be defined.« less
  • Purpose: This study retrospectively examines the long-term therapeutic outcomes of 32 patients with primary spinal cord gliomas at Massachusetts General Hospital between 1991 and 2005 treated by either photon intensity-modulated radiotherapy or conformal proton radiotherapy. Methods and Materials: Individual patient tumor types included 14 ependymomas, 17 astrocytomas, and one oligodendroglioma. Twenty-two patients were treated with photon beam radiation therapy, and 10 patients were treated with proton beam therapy. The overall survival and time to progression were analyzed. Average radiation dose for patients was 51 Gy in 1.8 median daily fractions over 29 treatments. Results: For all 32 patients, the overallmore » 5-year survival was 65% and the progression-free survival was 61%, respectively. Overall survival was significantly worse for patients more than 55 years of age (p = 0.02). Ependymoma patients had significantly longer survival times than astrocytoma patients (p = 0.05). Patients who had undergone a biopsy developed worse outcomes then those with a resection (p = 0.05). With the caveat of a limited number of patients, the multivariate model seems to suggest improved overall survival for younger patients (<54 years of age), ependymoma histology, and photon vs. proton treatment. Conclusion: For patients with spinal cord gliomas, significant factors associated with patient outcome include tumor pathology, age, extent of surgery, and treatment.« less
  • Purpose: To retrospectively analyze the results of intraoperative radiotherapy (IORT) with or without external beam radiotherapy (EBRT) for resected pancreatic cancer. Methods and Materials: The records of 210 patients treated with gross complete resection (R0: 147 patients; R1: 63 patients) and IORT with or without EBRT were reviewed. One hundred forty-seven patients (70.0%) were treated without EBRT and 114 patients (54.3%) were treated in conjunction with chemotherapy. The median doses of IORT and EBRT were 25 Gy (range, 20-30 Gy) and 45 Gy (range, 20-60Gy), respectively. The median follow-up of the surviving 62 patients was 26.3 months (range, 2.7-90.5 months).more » Results: At the time of this analysis, 150 of 210 patients (71.4%) had disease recurrences. Local failure was observed in 31 patients (14.8%), and the 2-year local control rate in all patients was 83.7%. The median survival time and the 2-year actuarial overall survival (OS) in all 210 patients were 19.1 months and 42.1%, respectively. Patients treated with IORT and chemotherapy had a significantly more favorable OS than those treated with IORT alone (p = 0.0011). On univariate analysis, chemotherapy use, degree of resection, carbohydrate antigen 19-9, and pathological N stage had a significant impact on OS and on multivariate analysis; these four factors were significant prognostic factors. Late gastrointestinal morbidity of NCI-CTC Grade 4 was observed in 7 patients (3.3%). Conclusion: IORT yields an excellent local control rate for resected pancreatic cancer with few frequencies of severe late toxicity, and IORT combined with chemotherapy confers a survival benefit compared with that of IORT alone.« less
  • Purpose: To retrospectively analyze the results of intraoperative radiotherapy (IORT) + external beam radiotherapy (EBRT) for unresectable pancreatic cancer. Methods and Materials: The records of 144 patients treated with IORT, with or without, EBRT were reviewed. One hundred and thirteen patients (78.5%) were treated with IORT + EBRT and 114 patients (79.2%) were treated in conjunction with chemotherapy. The median doses of IORT and EBRT were 25 Gy and 45 Gy, respectively. The median follow-up of all 144 patients was 9.6 months (range, 0.5-69.7 months). Results: At the time of this analysis, 131 of 144 patients (91.0%) had disease recurrences.more » Local progression was observed in 60 patients (41.7%), and the 2-year local control (LC) rate in all patients was 44.6%. Patients treated with IORT, with or without, EBRT had significantly more favorable LC (2-year LC, 50.9%) than those treated with IORT without EBRT (p = 0.0004). The 2-year overall survival (OS) rate and the median survival time in all 144 patients were 14.7% and 10.5 months, respectively. Patients treated with chemotherapy had a significantly favorable OS than those treated without chemotherapy (p < 0.0001). On univariate analysis, chemotherapy use alone had a significant impact on OS and on multivariate analysis; chemotherapy use was a significant prognostic factor. Late gastrointestinal morbidity of National Cancer Institute-Common Terminology Criteria Grade 3 was observed in 2 patients (1.4%). Conclusion: IORT + EBRT yields a relatively favorable LC rate for unresectable pancreatic cancer with low frequency of severe late toxicity, and IORT combined with chemotherapy conferred a survival benefit compared with IORT without chemotherapy.« less
  • Local irradiation tests were carried out on the spinal cord and the shin of rabbits for the purpose of obtaining more information on the direct and reflex action of radiation on the hypothalamic region. Of the 25 animals, 5 were used for control and each of the 2 groups of 10 animals was used for irradiating either the spinal cord or the shin. The hypothalamus was excited by means of electrodes. The amplitude of the current of the flexor action, their frequency, and the latent period of the bending reflex were determined. Hard x rays were directed on the lumbarmore » vertebrae and soft radiation was applied on the lower third portion of the leg, using a dose of 1000 r. It was found that in the case a strong depression of the spinal centers, irritation of the hypothalamus stimulates the reflex activity. Increase of the excitability of the subtubercular region seemed to be one of the reasons of the depression of spinal reflexes. Change of the state of hypothalamus, noticed after irradiation of the shin of the animals, points toward the reflex-type nature of this disturbance. (TTT)« less