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Management of pediatric spinal cord astrocytomas: outcomes with adjuvant radiation
Zachary D Guss1, Shalini Moningi, George I Jallo
1Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Insights
Pediatric spinal cord astrocytomas, though rare, show better outcomes for low-grade tumors. Radiation therapy may improve tumor control with manageable side effects in children.
Area of Science:
- Pediatric Oncology
- Neurosurgery
- Radiation Oncology
Background:
- Pediatric intramedullary spinal cord tumors are rare, with astrocytomas being the most common type.
- Accurate diagnosis and treatment are crucial for managing these challenging pediatric neoplasms.
Purpose of the Study:
- To evaluate treatment outcomes for pediatric patients diagnosed with spinal cord astrocytomas.
- To analyze prognostic factors influencing disease progression and survival in this cohort.
Main Methods:
- Retrospective analysis of pediatric patients with spinal cord astrocytomas treated between 1990 and 2010.
- Assessment of extent of resection, progression-free survival (PFS), and radiation-related toxicities.
- Kaplan-Meier curves and multivariate regression models were employed for data analysis.
Main Results:
- Twenty-nine patients were included: 24 with low-grade (1-2) and 5 with high-grade (3-4) astrocytomas.
- Median follow-up was 55 months for low-grade and 17 months for high-grade tumors.
- Fifteen low-grade and one high-grade tumor showed stable disease; all low-grade patients survived, with manageable radiation toxicities.
Conclusions:
- Histopathologic grade is a significant prognostic factor in pediatric spinal cord astrocytomas.
- Low-grade tumors demonstrate excellent disease control and long-term survival.
- Radiation therapy appears beneficial for tumor control with acceptable toxicity in pediatric patients.
Purpose:
Pediatric intramedullary spinal cord tumors are exceedingly rare; in the United States, 100 to 200 cases are recognized annually, of these, most are astrocytomas. The purpose of this study is to report the outcomes in pediatric patients with spinal cord astrocytomas treated at a tertiary care center.
Methods And Materials:
An institutional review board-approved retrospective single-institution study was performed for pediatric patients with spinal cord astrocytomas treated at our hospital from 1990 to 2010. The patients were evaluated on the extent of resection, progression-free survival (PFS), and development of radiation-related toxicities. Kaplan-Meier curves and multivariate regression model methods were used for analysis.
Results:
Twenty-nine patients were included in the study, 24 with grade 1 or 2 (low-grade) tumors and 5 with grade 3 or 4 (high-grade) tumors. The median follow-up time was 55 months (range, 1-215 months) for patients with low-grade tumors and 17 months (range, 10-52 months) for those with high-grade tumors. Thirteen patients in the cohort received chemotherapy. All patients underwent at least 1 surgical resection. Twelve patients received radiation therapy to a median radiation dose of 47.5 Gy (range, 28.6-54.0 Gy). Fifteen patients with low-grade tumors and 1 patient with a high-grade tumor exhibited stable disease at the last follow-up visit. Acute toxicities of radiation therapy were low grade, whereas long-term sequelae were infrequent and manageable when they arose. All patients with low-grade tumors were alive at the last follow-up visit, compared with 1 patient with a high-grade tumor.
Conclusion:
Primary pediatric spinal cord astrocytomas vary widely in presentation and clinical course. Histopathologic grade remains a major prognostic factor. Patients with low-grade tumors tend to have excellent disease control and long-term survival compared to those with high-grade tumors. This experience suggests that radiation therapy may enhance tumor control with an acceptably low risk of long-term sequelae in this sensitive patient population.
