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Extent of surgical resection of malignant astrocytomas of the spinal cord: outcome analysis of 35 patients.
Neurosurgery. 2008 Jul; 63(1):55-60; discussion 60-1.N

Abstract

OBJECTIVE

The optimal management of malignant intramedullary spinal cord astrocytomas remains controversial. Although radiotherapy has become the standard of care, the relationship between extent of resection and survival remains unclear. We report the outcomes of the surgical management of 35 malignant spinal cord astrocytomas and assess the association of extent of resection with survival after aggressive resection of these tumors.

METHODS

An institutional intramedullary spinal cord tumor database (1990-2002) was reviewed to identify all patients treated for malignant astrocytomas of the spinal cord (anaplastic astrocytoma [AA] or glioblastoma multiforme [GBM]). Length of survival from surgery was charted by Kaplan-Meier plots, and association of extent of resection with survival was assessed via log rank analysis for stratified covariates and Cox proportional-hazards model for continuous covariates.

RESULTS

Twenty-seven (77%) and eight (23%) patients underwent resection of AA and GBM, respectively. Mean age was 29 +/-16 years (range, 2-61 yr). Tumor involved six +/- four vertebral levels. For AA cases, radical resection (no residual postoperative magnetic resonance enhancement) was achieved in 12 (44%) patients and subtotal resection (residual postoperative magnetic resonance enhancement) was achieved in 15 (56%). No GBM patients underwent radical resection (mean estimated resection, 70%). After surgery, two (6%) patients improved neurologically by modified McCormick score, 19 (54%) remained stable, and 14 (40%) declined. Median overall survival for AA patients was 72 months (85% at 1 yr; 59% at 5 yr). Median overall survival for GBM patients was 9 months (31% at 1 yr; 0% at 5 yr). Subtotal versus radical resection of AA was associated with decreased overall survival (38 versus 78% at 4 yr, P = 0.028). Postoperative tumor dissemination was associated with decreased survival (P = 0.004). When adjusting for multiple comparisons (P < 0.006 needed for significance), a trend of increased survival was observed with radical resection (P = 0.023).

CONCLUSION

Neurological function can be preserved with aggressive resection of malignant intramedullary spinal astrocytomas; however, motor decline may be observed in many cases. Radical resection of AA was associated with a trend of increased overall survival in nondisseminated AA cases. Radical surgery and radiotherapy of GBM was associated with poor survival, similar to historical controls of diagnostic biopsy and radiotherapy. A markedly shorter survival may be expected in cases in which AA disseminates along the neuraxis. Biopsy alone may not provide the best outcomes for patients with malignant spinal cord tumors.

Authors+Show Affiliations

Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland 21218, USA. mmcgirt1@jhmi.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

18728568

Citation

McGirt, Matthew J., et al. "Extent of Surgical Resection of Malignant Astrocytomas of the Spinal Cord: Outcome Analysis of 35 Patients." Neurosurgery, vol. 63, no. 1, 2008, pp. 55-60; discussion 60-1.
McGirt MJ, Goldstein IM, Chaichana KL, et al. Extent of surgical resection of malignant astrocytomas of the spinal cord: outcome analysis of 35 patients. Neurosurgery. 2008;63(1):55-60; discussion 60-1.
McGirt, M. J., Goldstein, I. M., Chaichana, K. L., Tobias, M. E., Kothbauer, K. F., & Jallo, G. I. (2008). Extent of surgical resection of malignant astrocytomas of the spinal cord: outcome analysis of 35 patients. Neurosurgery, 63(1), 55-60; discussion 60-1. https://doi.org/10.1227/01.NEU.0000335070.37943.09
McGirt MJ, et al. Extent of Surgical Resection of Malignant Astrocytomas of the Spinal Cord: Outcome Analysis of 35 Patients. Neurosurgery. 2008;63(1):55-60; discussion 60-1. PubMed PMID: 18728568.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Extent of surgical resection of malignant astrocytomas of the spinal cord: outcome analysis of 35 patients. AU - McGirt,Matthew J, AU - Goldstein,Ira M, AU - Chaichana,Kaisorn L, AU - Tobias,Michael E, AU - Kothbauer,Karl F, AU - Jallo,George I, PY - 2008/8/30/pubmed PY - 2009/1/23/medline PY - 2008/8/30/entrez SP - 55-60; discussion 60-1 JF - Neurosurgery JO - Neurosurgery VL - 63 IS - 1 N2 - OBJECTIVE: The optimal management of malignant intramedullary spinal cord astrocytomas remains controversial. Although radiotherapy has become the standard of care, the relationship between extent of resection and survival remains unclear. We report the outcomes of the surgical management of 35 malignant spinal cord astrocytomas and assess the association of extent of resection with survival after aggressive resection of these tumors. METHODS: An institutional intramedullary spinal cord tumor database (1990-2002) was reviewed to identify all patients treated for malignant astrocytomas of the spinal cord (anaplastic astrocytoma [AA] or glioblastoma multiforme [GBM]). Length of survival from surgery was charted by Kaplan-Meier plots, and association of extent of resection with survival was assessed via log rank analysis for stratified covariates and Cox proportional-hazards model for continuous covariates. RESULTS: Twenty-seven (77%) and eight (23%) patients underwent resection of AA and GBM, respectively. Mean age was 29 +/-16 years (range, 2-61 yr). Tumor involved six +/- four vertebral levels. For AA cases, radical resection (no residual postoperative magnetic resonance enhancement) was achieved in 12 (44%) patients and subtotal resection (residual postoperative magnetic resonance enhancement) was achieved in 15 (56%). No GBM patients underwent radical resection (mean estimated resection, 70%). After surgery, two (6%) patients improved neurologically by modified McCormick score, 19 (54%) remained stable, and 14 (40%) declined. Median overall survival for AA patients was 72 months (85% at 1 yr; 59% at 5 yr). Median overall survival for GBM patients was 9 months (31% at 1 yr; 0% at 5 yr). Subtotal versus radical resection of AA was associated with decreased overall survival (38 versus 78% at 4 yr, P = 0.028). Postoperative tumor dissemination was associated with decreased survival (P = 0.004). When adjusting for multiple comparisons (P < 0.006 needed for significance), a trend of increased survival was observed with radical resection (P = 0.023). CONCLUSION: Neurological function can be preserved with aggressive resection of malignant intramedullary spinal astrocytomas; however, motor decline may be observed in many cases. Radical resection of AA was associated with a trend of increased overall survival in nondisseminated AA cases. Radical surgery and radiotherapy of GBM was associated with poor survival, similar to historical controls of diagnostic biopsy and radiotherapy. A markedly shorter survival may be expected in cases in which AA disseminates along the neuraxis. Biopsy alone may not provide the best outcomes for patients with malignant spinal cord tumors. SN - 1524-4040 UR - https://www.unboundmedicine.com/medline/citation/18728568/Extent_of_surgical_resection_of_malignant_astrocytomas_of_the_spinal_cord:_outcome_analysis_of_35_patients_ L2 - https://academic.oup.com/neurosurgery/article-lookup/doi/10.1227/01.NEU.0000335070.37943.09 DB - PRIME DP - Unbound Medicine ER -