scholarly journals Clinical and pathological outcomes after resection of intramedullary spinal cord tumors: a single-institution case series

2016 ◽  
Vol 41 (2) ◽  
pp. E8 ◽  
Author(s):  
Nardin Samuel ◽  
Lindsay Tetreault ◽  
Carlo Santaguida ◽  
Anick Nater ◽  
Nizar Moayeri ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Tumor Progression ◽  
Functional Outcomes ◽  
Univariate Analysis ◽  
Case Series ◽  
Progression Free Survival ◽  
Spinal Cord Tumors ◽  
Intramedullary Spinal Cord ◽  
Free Survival ◽  
Tumor Pathology

OBJECTIVE The objective of this study was to identify clinically relevant predictors of progression-free survival and functional outcomes in patients who underwent surgery for intramedullary spinal cord tumors (ISCTs). METHODS An institutional spinal tumor registry and billing records were reviewed to identify adult patients who underwent resection of ISCTs between 1993 and 2014. Extensive data were collected from patient charts and operative notes, including demographic information, extent of resection, tumor pathology, and functional and oncological outcomes. Survival analysis was used to determine important predictors of progression-free survival. Logistic regression analysis was used to evaluate the association between an “optimal” functional outcome on the Frankel or McCormick scale at 1-year follow-up and various clinical and surgical characteristics. RESULTS The consecutive case series consisted of 63 patients (50.79% female) who underwent resection of ISCTs. The mean age of patients was 41.92 ± 14.36 years (range 17.60–75.40 years). Complete microsurgical resection, defined as no evidence of tumor on initial postoperative imaging, was achieved in 34 cases (54.84%) of the 62 patients for whom this information was available. On univariate analysis, the most significant predictor of progression-free survival was tumor histology (p = 0.0027). Patients with Grade I/II astrocytomas were more likely to have tumor progression than patients with WHO Grade II ependymomas (HR 8.03, 95% CI 2.07–31.11, p = 0.0026) and myxopapillary ependymomas (HR 8.01, 95% CI 1.44–44.34, p = 0.017). Furthermore, patients who underwent radical or subtotal resection were more likely to have tumor progression than those who underwent complete resection (HR 3.46, 95% CI 1.23–9.73, p = 0.018). Multivariate analysis revealed that tumor pathology was the only significant predictor of tumor progression. On univariate analysis, the most significant predictors of an “optimal” outcome on the Frankel scale were age (OR 0.94, 95% CI 0.89–0.98, p = 0.0062), preoperative Frankel grade (OR 4.84, 95% CI 1.33–17.63, p = 0.017), McCormick score (OR 0.22, 95% CI 0.084–0.57, p = 0.0018), and region of spinal cord (cervical vs conus: OR 0.067, 95% CI 0.012–0.38, p = 0.0023; and thoracic vs conus: OR 0.015: 95% CI 0.001–0.20, p = 0.0013). Age, tumor pathology, and region were also important predictors of 1-year McCormick scores. CONCLUSIONS Extent of tumor resection and histopathology are significant predictors of progression-free survival following resection of ISCTs. Important predictors of functional outcomes include tumor histology, region of spinal cord in which the tumor is present, age, and preoperative functional status.

TM1-6 Intramedullary spinal cord tumours – a single centre 10 year retrospective review

2019 ◽  
Vol 90 (3) ◽  
pp. e10.1-e10
Author(s):  
O Richards ◽  
E Goacher ◽  
C Derham
Keyword(s):  
Spinal Cord ◽  
Significant Relationship ◽  
Retrospective Review ◽  
Progression Free Survival ◽  
Extent Of Resection ◽  
Tumour Resection ◽  
Anatomical Location ◽  
Intramedullary Spinal Cord ◽  
Free Survival ◽  
Spinal Cord Tumours

ObjectivesTo identify clinically relevant predictors of progression free survival by retrospectively analysing the anatomical location, pre- and post-operative function and histology in intramedullary spinal cord tumours from a single neurosurgical centre over 10 years.DesignRetrospective review.Methods49 patients were identified from a surgical database. Variables collected included pre-and post-operative Frankel Grade and Modified McCormick Scale assessments, tumour histology, extent of resection and length of follow up. Chi-Squared, Kaplan-Mier Survival and Mann-Whitney U-Tests were completed.ResultsThere was a statistically significant relationship between identification of the tumour plane and extent of resection (p<0.01), along with the extent of resection and recurrence (p<0.01). Compared to the other histological subtypes, ependymoma’s demonstrated a significantly greater extent of resection (p=0.02). There was a significant relationship between the grade of tumour and progression free survival (p<0.01). We did not find a significant relationship between pre- and post-operative neurological function and survival.ConclusionsTumour plane and the extent of tumour resection are significant determinants of progression free survival. Ependymoma, whilst being the commonest histology in our series were also the most resectable. Whilst complete resection reduces the rate of recurrence, tumour grade is the most important predictor of outcome.

scholarly journals Intramedullary spinal cord tumor resection

2012 ◽  
Vol 33 (Suppl1) ◽  
pp. 1
Author(s):  
Mari L. Groves ◽  
Patricia L. Zadnik ◽  
Pablo F. Recinos ◽  
Violette Renard ◽  
George I. Jallo
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Tumor ◽  
Tumor Resection ◽  
Progression Free Survival ◽  
Low Grade ◽  
High Definition ◽  
En Bloc ◽  
Intramedullary Spinal Cord ◽  
Free Survival ◽  
Intramedullary Spinal Cord Tumor

The authors present a case of a 27-year-old patient who presented with spastic gait and worsening difficulty walking over a 6 month period. Spinal MR imaging revealed a heterogeneously enhancing intramedullary spinal cord tumor (IMSCT) with associated syrinx in the cervical spine. The lesion was resected through posterior en bloc laminotomy, durotomy, and microscopic resection of the intramedullary component followed by laminoplasty reconstruction. Surgical resections with a goal of gross total resection can significantly improve overall survival and progression free survival in patients with low-grade IMSCT. The procedure is presented in an edited, high-definition format with accompanying narrative. The video can be found here: http://youtu.be/Ui9bn82PtP8.

Survival and functional outcome of childhood spinal cord low-grade gliomas

2009 ◽  
Vol 4 (3) ◽  
pp. 254-261 ◽  
Author(s):  
Katrin Scheinemann ◽  
Ute Bartels ◽  
Annie Huang ◽  
Cynthia Hawkins ◽  
Abhaya V. Kulkarni ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Pediatric Patients ◽  
Progression Free Survival ◽  
Spinal Tumors ◽  
High Morbidity ◽  
Low Grade ◽  
Aggressive Approach ◽  
Intramedullary Spinal Cord ◽  
Free Survival ◽  
Low Grade Gliomas

Object Intramedullary spinal cord low-grade gliomas (LGGs) are rare CNS neoplasms in pediatric patients, and there is little information on therapy for and outcome of these tumors in this population. Furthermore, most patient series combine adult and pediatric patients or high- and low-grade tumors, resulting in controversial data regarding optimal treatment of these children. To clarify these issues, the authors performed a regional population-based study of spinal cord LGGs in pediatric patients. Methods All pediatric patients with LGGs treated during the MR imaging era (1985–2007) were identified in the comprehensive database of the Hospital for Sick Children in Toronto. Data on demographics, pathology, treatment details, and outcomes were collected. Results Spinal cord LGGs in pediatric patients constituted 29 (4.6%) of 635 LGGs. Epidemiological and clinical data in this cohort were different than in patients with other spinal tumors and strikingly similar to data from pediatric patients with intracranial LGGs. The authors observed an age peak at 2 years and a male predominance in patients with these tumors. Histological testing revealed a Grade I astrocytoma in 86% of tumors. Although 5-year progression-free survival for the entire group was 48 ± 9%, all patients were alive at a median follow-up of 8.2 years. Five-year progression-free survival was 88 ± 13% for patients undergoing gross-total resection and 34 ± 11% for those undergoing all other therapies, respectively (p = 0.02). Chemotherapy and radiation therapy showed similar efficacy, achieving sustained tumor control in most patients. However, this excellent survival rate was associated with an 83% rate of significant neurological and orthopedic sequelae. Conclusions This study provides basic data on the incidence, clinical course, and outcome of spinal cord LGGs in pediatric patients. The similarities between spinal and intracranial LGGs in pediatric patients showing excellent survival but high morbidity suggest that a less aggressive approach may be the preferable treatment option for these patients.

scholarly journals A preoperative risk classifier that predicts tumor progression in patients with cranial base chondrosarcomas

2020 ◽  
pp. 1-9
Author(s):  
Andrew S. Venteicher ◽  
Michael M. McDowell ◽  
Ezequiel Goldschmidt ◽  
Eric W. Wang ◽  
Carl H. Snyderman ◽  
...  
Keyword(s):  
Tumor Progression ◽  
Univariate Analysis ◽  
Progression Free Survival ◽  
Cranial Base ◽  
Point System ◽  
Multivariate Regression Model ◽  
Preoperative Risk ◽  
Free Survival ◽  
Risk Stratification Model ◽  
Two Factors

OBJECTIVEThe authors conducted a study to identify clinical features of cranial base chondrosarcomas that will predict tumor progression after resection.METHODSThe authors performed a retrospective study at a tertiary referral cranial base center. Patients who underwent resection of cranial base chondrosarcomas between January 2004 and December 2018 were followed longitudinally. The main outcome measure was progression-free survival (PFS).RESULTSA total of 41 patients were treated for histopathologically proven “conventional” cranial base chondrosarcomas during the study period, and the median PFS was 123 months for the cohort. Univariate analysis was performed on clinical, anatomical, and radiographic parameters collected for each patient. Features that were statistically significant were fed into a multivariate regression model, which revealed two independent predictors of PFS: patient age and encasement of 3–4 major arteries (> 25% of the vessel wall surrounded by tumor). Using these two variables of age and multiple arterial vessel encasement, the authors generated a risk stratification model using a simple point system to predict PFS in patients with cranial base chondrosarcomas. Based on these two factors known preoperatively, this model could stratify patients into high-risk (10% of patients), intermediate-risk (68% of patients), and low-risk (22% of patients) subgroups corresponding to dramatically distinct median PFS (1.8 years, 10.2 years, and no progression, respectively).CONCLUSIONSIn patients with cranial base chondrosarcomas, age and artery encasement are variables known preoperatively that can powerfully predict tumor progression, define operative goals, and aid in selecting postoperative adjuvant therapy.

scholarly journals Temozolomide therapy for aggressive functioning pituitary adenomas refractory to surgery and radiation: a case series

2017 ◽  
Vol 5 (1) ◽  
pp. 64-68 ◽  
Author(s):  
Justin T Jordan ◽  
Julie J Miller ◽  
Tucker Cushing ◽  
Marlon Seijo ◽  
Tracy T Batchelor ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Case Series ◽  
Pituitary Tumors ◽  
Retrospective Chart Review ◽  
Progression Free Survival ◽  
Response To Therapy ◽  
Chemotherapeutic Regimen ◽  
Free Survival ◽  
Tumor Pathology ◽  
Multimodality Approach

Abstract Background Treatment of aggressive pituitary adenomas typically involves a multimodality approach based on histopathological features and may include pharmacotherapy, surgery, and occasionally radiation therapy. In cases of treatment-refractory tumor progression, chemotherapy may be considered; however, no standard chemotherapeutic regimen has been established. Literature review suggests that temozolomide may have a beneficial role in a subset of cases. To understand the efficacy of temozolomide in progressive pituitary tumors, we reviewed the outcomes of cases at our center. Methods We performed a retrospective chart review to report the outcome and unique features of 7 patients with aggressive functioning pituitary adenomas or carcinomas treated with temozolomide. Tumor pathology included somatotroph (n = 1), corticotroph (n = 3), and lactotroph (n = 3) tumors. Results Four of the 7 patients had at least 2 prior resections, and all had prior radiation and surgery before treatment with temozolomide. Notably, all patients showed response to therapy, defined as either stable disease (43%) or partial response (57%). Median progression-free survival was 1.66 years, and median overall survival was 4 years. Conclusion Our data suggest that temozolomide has an important role in the management of aggressive functioning pituitary tumors that are resistant to standard therapies, and that optimization of therapy with temozolomide may involve individualized regimens. Future prospective clinical trials should be considered.

Factors associated with progression-free survival and long-term neurological outcome after resection of intramedullary spinal cord tumors: analysis of 101 consecutive cases

2009 ◽  
Vol 11 (5) ◽  
pp. 591-599 ◽  
Author(s):  
Giannina L. Garcés-Ambrossi ◽  
Matthew J. McGirt ◽  
Vivek A. Mehta ◽  
Daniel M. Sciubba ◽  
Timothy F. Witham ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Progression Free Survival ◽  
Total Resection ◽  
Intramedullary Spinal Cord ◽  
Free Survival ◽  
Factors Associated ◽  
Neurological Improvement ◽  
Pathological Type

Object With the introduction of electrophysiological spinal cord monitoring, surgeons have been able to perform radical resection of intramedullary spinal cord tumors (IMSCTs). However, factors associated with tumor resectability, tumor recurrence, and long-term neurological outcome are poorly understood. Methods The authors retrospectively reviewed 101 consecutive cases of IMSCT resection in adults and children at a single institution. Neurological function and MR images were evaluated preoperatively, at discharge, 1 month after surgery, and every 6 months thereafter. Factors associated with gross-total resection (GTR), progression-free survival (PFS), and long-term neurological improvement were assessed using multivariate regression analysis. Results The mean age of the patients was 41 ± 18 years and 17 (17%) of the patients were pediatric. Pathological type included ependymoma in 51 cases, hemangioblastoma in 15, pilocytic astrocytoma in 16, WHO Grade II astrocytoma in 10, and malignant astrocytoma in 9. A GTR was achieved in 60 cases (59%). Independent of histological tumor type, an intraoperatively identifiable tumor plane (OR 25.3, p < 0.0001) and decreasing tumor size (OR 1.2, p = 0.05) were associated with GTR. Thirty-four patients (34%) experienced acute neurological decline after surgery (associated with increasing age [OR 1.04, p = 0.02] and with intraoperative change in motor evoked potentials [OR 7.4, p = 0.003]); in 14 (41%) of these patients the change returned to preoperative baseline within 1 month. In 31 patients (31%) tumor progression developed by last follow-up (mean 19 months). Tumor histology (p < 0.0001) and the presence of an intraoperatively identified tumor plane (hazard ratio [HR] 0.44, p = 0.027) correlated with improved PFS. A GTR resulted in improved PFS for hemangioblastoma (HR 0.004, p = 0.04) and ependymoma (HR 0.2, p = 0.02), but not astrocytoma. Fifty-five patients (55%) maintained overall neurological improvement by last follow-up. The presence of an identifiable tumor plane (HR 3.1, p = 0.0004) and improvement in neurological symptoms before discharge (HR 2.3, p = 0.004) were associated with overall neurological improvement by last follow-up (mean 19 months). Conclusions Gross-total resection can be safely achieved in the vast majority of IMSCTs when an intraoperative plane is identified, independent of pathological type. The incidence of acute perioperative neurological decline increases with patient age but will improve to baseline in nearly half of patients within 1 month. Long-term improvement in motor, sensory, and bladder dysfunction may be achieved in a slight majority of patients and occurs more frequently in patients in whom a surgical plane can be identified. A GTR should be attempted for ependymoma and hemangioblastoma, but it may not affect PFS for astrocytoma. For all tumors, the intraoperative finding of a clear tumor plane of resection carries positive prognostic significance across all pathological types.

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