Clinical Factors for Prognosis and Treatment Guidance of Spinal Cord Astrocytoma
Study DesignRetrospective study.PurposeTo obtain information useful in establishing treatment guidelines by evaluating baseline clinical features and treatment outcomes of patients with spinal cord astrocytoma (SCA).Overview of LiteratureThe optimal management of SCA remains controversial, and there...
Main Authors: | , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Korean Spine Society
2016-08-01
|
Series: | Asian Spine Journal |
Subjects: | |
Online Access: | http://www.asianspinejournal.org/upload/pdf/asj-10-748.pdf |
id |
doaj-e868bc3e90034fc1ab8892665d57585f |
---|---|
record_format |
Article |
spelling |
doaj-e868bc3e90034fc1ab8892665d57585f2020-11-25T00:13:42ZengKorean Spine SocietyAsian Spine Journal1976-19021976-78462016-08-0110474875410.4184/asj.2016.10.4.748147Clinical Factors for Prognosis and Treatment Guidance of Spinal Cord AstrocytomaToshitaka Seki0Kazutoshi Hida1Shunsuke Yano2Takeshi Aoyama3Izumi Koyanagi4Toru Sasamori5Shuji Hamauch6Kiyohiro Houkin7Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.Department of Neurosurgery, Sapporo Azabu Neurosurgical Hospital, Sapporo, Japan.Department of Neurosurgery, Sapporo Azabu Neurosurgical Hospital, Sapporo, Japan.Department of Orthopedic Surgery, Teine Keijinkai Hospital, Sapporo, Japan.Department of Neurosurgery, Hokkaido Neurosurgical Memorial Hospital, Sapporo, Japan.Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.Study DesignRetrospective study.PurposeTo obtain information useful in establishing treatment guidelines by evaluating baseline clinical features and treatment outcomes of patients with spinal cord astrocytoma (SCA).Overview of LiteratureThe optimal management of SCA remains controversial, and there are no standard guidelines.MethodsThe study included 20 patients with low-grade and 13 with high-grade SCA surgically treated between 1989 and 2014. Patients were classified according to the extent of surgical resection. Survival was assessed using Kaplan–Meier plots and compared between groups by log-rank tests. Neurological status was defined by the modified McCormick scale and compared between groups by Mann–Whitney U tests.ResultsSurgical resection was performed for 19 of 20 low-grade (95%) and 10 of 13 high-grade (76.9%) SCA patients. Only nine patients (27.3%) underwent gross total resection, all of whom had low-grade SCA. Of all patients, 51.5% showed deteriorated neurological status compared to preoperative baseline. Median overall survival was significantly longer for low-grade SCA than that (91 months, 78% at 5 years vs. 15 months, 31% at 5 years; p=0.007). Low-grade SCA patients benefited from more aggressive resection, whereas high-grade SCA patients did not. Multivariate analysis revealed histology status (hazard ratio [HR], 0.30; 95% confidence interval [CI], 0.09–0.98; p<0.05) and postoperative neurological status (HR, 0.12; CI, 0.02–0.95; p<0.05) as independent predictors of longer overall survival. Adjuvant radiotherapy had no significant impact on survival rate. However, a trend for increased survival was observed with radiation cordotomy (RCT) in high-grade SCA patients.ConclusionsAggressive resection for low-grade and RCT may prolong survival. Preservation of neurological status is an important treatment goal. Given the low incidence of SCA, establishing strong collaborative, interdisciplinary, and multi-institutional study groups is necessary to define optimal treatments.http://www.asianspinejournal.org/upload/pdf/asj-10-748.pdfAstrocytomaIntramedullary tumorOutcomeRadiotherapySurgery |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Toshitaka Seki Kazutoshi Hida Shunsuke Yano Takeshi Aoyama Izumi Koyanagi Toru Sasamori Shuji Hamauch Kiyohiro Houkin |
spellingShingle |
Toshitaka Seki Kazutoshi Hida Shunsuke Yano Takeshi Aoyama Izumi Koyanagi Toru Sasamori Shuji Hamauch Kiyohiro Houkin Clinical Factors for Prognosis and Treatment Guidance of Spinal Cord Astrocytoma Asian Spine Journal Astrocytoma Intramedullary tumor Outcome Radiotherapy Surgery |
author_facet |
Toshitaka Seki Kazutoshi Hida Shunsuke Yano Takeshi Aoyama Izumi Koyanagi Toru Sasamori Shuji Hamauch Kiyohiro Houkin |
author_sort |
Toshitaka Seki |
title |
Clinical Factors for Prognosis and Treatment Guidance of Spinal Cord Astrocytoma |
title_short |
Clinical Factors for Prognosis and Treatment Guidance of Spinal Cord Astrocytoma |
title_full |
Clinical Factors for Prognosis and Treatment Guidance of Spinal Cord Astrocytoma |
title_fullStr |
Clinical Factors for Prognosis and Treatment Guidance of Spinal Cord Astrocytoma |
title_full_unstemmed |
Clinical Factors for Prognosis and Treatment Guidance of Spinal Cord Astrocytoma |
title_sort |
clinical factors for prognosis and treatment guidance of spinal cord astrocytoma |
publisher |
Korean Spine Society |
series |
Asian Spine Journal |
issn |
1976-1902 1976-7846 |
publishDate |
2016-08-01 |
description |
Study DesignRetrospective study.PurposeTo obtain information useful in establishing treatment guidelines by evaluating baseline clinical features and treatment outcomes of patients with spinal cord astrocytoma (SCA).Overview of LiteratureThe optimal management of SCA remains controversial, and there are no standard guidelines.MethodsThe study included 20 patients with low-grade and 13 with high-grade SCA surgically treated between 1989 and 2014. Patients were classified according to the extent of surgical resection. Survival was assessed using Kaplan–Meier plots and compared between groups by log-rank tests. Neurological status was defined by the modified McCormick scale and compared between groups by Mann–Whitney U tests.ResultsSurgical resection was performed for 19 of 20 low-grade (95%) and 10 of 13 high-grade (76.9%) SCA patients. Only nine patients (27.3%) underwent gross total resection, all of whom had low-grade SCA. Of all patients, 51.5% showed deteriorated neurological status compared to preoperative baseline. Median overall survival was significantly longer for low-grade SCA than that (91 months, 78% at 5 years vs. 15 months, 31% at 5 years; p=0.007). Low-grade SCA patients benefited from more aggressive resection, whereas high-grade SCA patients did not. Multivariate analysis revealed histology status (hazard ratio [HR], 0.30; 95% confidence interval [CI], 0.09–0.98; p<0.05) and postoperative neurological status (HR, 0.12; CI, 0.02–0.95; p<0.05) as independent predictors of longer overall survival. Adjuvant radiotherapy had no significant impact on survival rate. However, a trend for increased survival was observed with radiation cordotomy (RCT) in high-grade SCA patients.ConclusionsAggressive resection for low-grade and RCT may prolong survival. Preservation of neurological status is an important treatment goal. Given the low incidence of SCA, establishing strong collaborative, interdisciplinary, and multi-institutional study groups is necessary to define optimal treatments. |
topic |
Astrocytoma Intramedullary tumor Outcome Radiotherapy Surgery |
url |
http://www.asianspinejournal.org/upload/pdf/asj-10-748.pdf |
work_keys_str_mv |
AT toshitakaseki clinicalfactorsforprognosisandtreatmentguidanceofspinalcordastrocytoma AT kazutoshihida clinicalfactorsforprognosisandtreatmentguidanceofspinalcordastrocytoma AT shunsukeyano clinicalfactorsforprognosisandtreatmentguidanceofspinalcordastrocytoma AT takeshiaoyama clinicalfactorsforprognosisandtreatmentguidanceofspinalcordastrocytoma AT izumikoyanagi clinicalfactorsforprognosisandtreatmentguidanceofspinalcordastrocytoma AT torusasamori clinicalfactorsforprognosisandtreatmentguidanceofspinalcordastrocytoma AT shujihamauch clinicalfactorsforprognosisandtreatmentguidanceofspinalcordastrocytoma AT kiyohirohoukin clinicalfactorsforprognosisandtreatmentguidanceofspinalcordastrocytoma |
_version_ |
1725393522441322496 |