Andrew M Hersh1, Albert Antar1, Zach Pennington2, Nafi Aygun3, Jaimin Patel1, Earl Goldsborough1, Jose L Porras1, Aladine A Elsamadicy4, Daniel Lubelski1, Jean-Paul Wolinsky5, George I Jallo6, Ziya L Gokaslan7, Sheng-Fu Larry Lo8, Daniel M Sciubba9,10,11. 1. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA. 2. Department of Neurosurgery, Mayo Clinic, Rochester, MN, 55905, USA. 3. Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiologic Science, The Johns Hopkins Hospital, Baltimore, MD, 21287, USA. 4. Department of Neurosurgery, Yale School of Medicine, New Haven, CT, 06520, USA. 5. Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA. 6. Department of Neurosurgery, Johns Hopkins Medicine, Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA. 7. Department of Neurosurgery, Brown University, Providence, RI, USA. 8. Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center, North Shore University Hospital, Northwell Health, Manhasset, NY, 11030, USA. 9. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA. dsciubba1@northwell.edu. 10. Department of Neurosurgery, Brown University, Providence, RI, USA. dsciubba1@northwell.edu. 11. , 300 Community Dr., 9 Tower, Manhasset, NY, 11030, USA. dsciubba1@northwell.edu.
Abstract
PURPOSE: Surgical resection is considered standard of care for primary intramedullary astrocytomas, but the infiltrative nature of these lesions often precludes complete resection without causing new post-operative neurologic deficits. Radiotherapy and chemotherapy serve as potential adjuvants, but high-quality data evaluating their efficacy are limited. Here we analyze the experience at a single comprehensive cancer center to identify independent predictors of postoperative overall and progression-free survival. METHODS: Data was collected on patient demographics, tumor characteristics, pre-operative presentation, resection extent, long-term survival, and tumor progression/recurrence. Kaplan-Meier curves modeled overall and progression-free survival. Univariable and multivariable accelerated failure time regressions were used to compute time ratios (TR) to determine predictors of survival. RESULTS: 94 patients were included, of which 58 (62%) were alive at last follow-up. On multivariable analysis, older age (TR = 0.98; p = 0.03), higher tumor grade (TR = 0.12; p < 0.01), preoperative back pain (TR = 0.45; p < 0.01), biopsy [vs GTR] (TR = 0.18; p = 0.02), and chemotherapy (TR = 0.34; p = 0.02) were significantly associated with poorer survival. Higher tumor grade (TR = 0.34; p = 0.02) and preoperative bowel dysfunction (TR = 0.31; p = 0.02) were significant predictors of shorter time to detection of tumor growth. CONCLUSION: Tumor grade and chemotherapy were associated with poorer survival and progression-free survival. Chemotherapy regimens were highly heterogeneous, and randomized trials are needed to determine if any optimal regimens exist. Additionally, GTR was associated with improved survival, and patients should be counseled about the benefits and risks of resection extent.
PURPOSE: Surgical resection is considered standard of care for primary intramedullary astrocytomas, but the infiltrative nature of these lesions often precludes complete resection without causing new post-operative neurologic deficits. Radiotherapy and chemotherapy serve as potential adjuvants, but high-quality data evaluating their efficacy are limited. Here we analyze the experience at a single comprehensive cancer center to identify independent predictors of postoperative overall and progression-free survival. METHODS: Data was collected on patient demographics, tumor characteristics, pre-operative presentation, resection extent, long-term survival, and tumor progression/recurrence. Kaplan-Meier curves modeled overall and progression-free survival. Univariable and multivariable accelerated failure time regressions were used to compute time ratios (TR) to determine predictors of survival. RESULTS: 94 patients were included, of which 58 (62%) were alive at last follow-up. On multivariable analysis, older age (TR = 0.98; p = 0.03), higher tumor grade (TR = 0.12; p < 0.01), preoperative back pain (TR = 0.45; p < 0.01), biopsy [vs GTR] (TR = 0.18; p = 0.02), and chemotherapy (TR = 0.34; p = 0.02) were significantly associated with poorer survival. Higher tumor grade (TR = 0.34; p = 0.02) and preoperative bowel dysfunction (TR = 0.31; p = 0.02) were significant predictors of shorter time to detection of tumor growth. CONCLUSION: Tumor grade and chemotherapy were associated with poorer survival and progression-free survival. Chemotherapy regimens were highly heterogeneous, and randomized trials are needed to determine if any optimal regimens exist. Additionally, GTR was associated with improved survival, and patients should be counseled about the benefits and risks of resection extent.
Authors: May Abdel-Wahab; Blessing Etuk; James Palermo; Hiroki Shirato; John Kresl; Ozlem Yapicier; Gail Walker; Bernd W Scheithauer; Edward Shaw; Charles Lee; Walter Curran; Terry Thomas; Arnold Markoe Journal: Int J Radiat Oncol Biol Phys Date: 2005-12-20 Impact factor: 7.038
Authors: Andrew M Hersh; Jaimin Patel; Zach Pennington; Jose L Porras; Earl Goldsborough; Albert Antar; Aladine A Elsamadicy; Daniel Lubelski; Jean-Paul Wolinsky; George Jallo; Ziya L Gokaslan; Sheng-Fu Larry Lo; Daniel M Sciubba Journal: J Neurosurg Spine Date: 2022-02-25
Authors: Giannina L Garcés-Ambrossi; Matthew J McGirt; Vivek A Mehta; Daniel M Sciubba; Timothy F Witham; Ali Bydon; Jean-Paul Wolinksy; George I Jallo; Ziya L Gokaslan Journal: J Neurosurg Spine Date: 2009-11
Authors: Andrew M Hersh; Meghana Bhimreddy; Carly Weber-Levine; Kelly Jiang; Safwan Alomari; Nicholas Theodore; Amir Manbachi; Betty M Tyler Journal: Cancers (Basel) Date: 2022-10-08 Impact factor: 6.575