Narihito Nagoshi1, Osahiko Tsuji2, Satoshi Suzuki2, Satoshi Nori2, Mitsuru Yagi2, Eijiro Okada2, Hajime Okita3, Nobuyuki Fujita4, Ken Ishii2,5,6, Morio Matsumoto2, Masaya Nakamura2, Kota Watanabe2. 1. Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan. nagoshi@2002.jukuin.keio.ac.jp. 2. Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan. 3. Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan. 4. Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Aichi, Japan. 5. Spine and Spinal Cord Center, International University of Health and Welfare, Mita Hospital, Tokyo, Japan. 6. Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Chiba, Japan.
Abstract
STUDY DESIGN: Retrospective cohort study. OBJECTIVES: Although intramedullary astrocytoma is associated with a high mortality rate, the optimal treatment has not reached a consensus. This study aimed at evaluating neurologic function and overall survival rate (OSR) in the treatment of this tumor. SETTING: The single institution in Japan. METHODS: This study enrolled 67 subjects who underwent surgical treatment for intramedullary astrocytoma. Demographic, imaging, and surgical information were collected from each participant. Tumors were histologically categorized using the World Health Organization classification, and subjects were divided into low-grade (I and II; n = 40) and high-grade (III and IV; n = 27) groups. Neurologic status was evaluated using the modified McCormick scale (MMS). OSR was assessed using Kaplan-Meier methods. RESULTS: The OSR decreased when the pathological grade increased (p < 0.01). Regarding the therapeutic efficacy for low-grade astrocytomas, subjects who underwent gross total resection (GTR) showed a higher OSR than those who did not (p = 0.02). GTR prevented worsening of MMS score, while non-GTR increased the MMS score (p < 0.01). In the high-grade group, 19 and 10 underwent radiation therapy and chemotherapy, respectively. However, both treatments did not improve OSR. Cordotomy was performed for subjects whose lesional area was at the thoracic level, but the OSR did not significantly increase. CONCLUSIONS: The most beneficial therapeutic strategy for low-grade astrocytomas was GTR, whereas that for the high-grade tumors was unclear. Further studies with a larger sample size are warranted to validate the effective treatment for malignant astrocytomas.
STUDY DESIGN: Retrospective cohort study. OBJECTIVES: Although intramedullary astrocytoma is associated with a high mortality rate, the optimal treatment has not reached a consensus. This study aimed at evaluating neurologic function and overall survival rate (OSR) in the treatment of this tumor. SETTING: The single institution in Japan. METHODS: This study enrolled 67 subjects who underwent surgical treatment for intramedullary astrocytoma. Demographic, imaging, and surgical information were collected from each participant. Tumors were histologically categorized using the World Health Organization classification, and subjects were divided into low-grade (I and II; n = 40) and high-grade (III and IV; n = 27) groups. Neurologic status was evaluated using the modified McCormick scale (MMS). OSR was assessed using Kaplan-Meier methods. RESULTS: The OSR decreased when the pathological grade increased (p < 0.01). Regarding the therapeutic efficacy for low-grade astrocytomas, subjects who underwent gross total resection (GTR) showed a higher OSR than those who did not (p = 0.02). GTR prevented worsening of MMS score, while non-GTR increased the MMS score (p < 0.01). In the high-grade group, 19 and 10 underwent radiation therapy and chemotherapy, respectively. However, both treatments did not improve OSR. Cordotomy was performed for subjects whose lesional area was at the thoracic level, but the OSR did not significantly increase. CONCLUSIONS: The most beneficial therapeutic strategy for low-grade astrocytomas was GTR, whereas that for the high-grade tumors was unclear. Further studies with a larger sample size are warranted to validate the effective treatment for malignant astrocytomas.
Authors: Hadie Adams; Javier Avendaño; Shaan M Raza; Ziya L Gokaslan; George I Jallo; Alfredo Quiñones-Hinojosa Journal: Spine (Phila Pa 1976) Date: 2012-05-20 Impact factor: 3.468
Authors: Ann Liu; Eric W Sankey; Chetan Bettegowda; Peter C Burger; George I Jallo; Mari L Groves Journal: J Clin Neurosci Date: 2015-06-30 Impact factor: 1.961
Authors: Roy Xiao; Kalil G Abdullah; Jacob A Miller; Daniel Lubelski; Michael P Steinmetz; John H Shin; Ajit A Krishnaney; Thomas E Mroz; Edward C Benzel Journal: Clin Neurol Neurosurg Date: 2016-03-14 Impact factor: 1.876
Authors: Kiernan J Minehan; Paul D Brown; Bernd W Scheithauer; William E Krauss; Michael P Wright Journal: Int J Radiat Oncol Biol Phys Date: 2008-08-05 Impact factor: 7.038
Authors: Matthew J McGirt; Ira M Goldstein; Kaisorn L Chaichana; Michael E Tobias; Karl F Kothbauer; George I Jallo Journal: Neurosurgery Date: 2008-07 Impact factor: 4.654
Authors: Andrew M Hersh; Albert Antar; Zach Pennington; Nafi Aygun; Jaimin Patel; Earl Goldsborough; Jose L Porras; Aladine A Elsamadicy; Daniel Lubelski; Jean-Paul Wolinsky; George I Jallo; Ziya L Gokaslan; Sheng-Fu Larry Lo; Daniel M Sciubba Journal: J Neurooncol Date: 2022-05-11 Impact factor: 4.130