Surgical outcomes of pediatric spinal cord astrocytomas: systematic review and meta-analysis

OBJECTIVEPediatric spinal astrocytomas are rare spinal lesions that pose unique management challenges. Therapeutic options include gross-total resection (GTR), subtotal resection (STR), and adjuvant chemotherapy or radiation therapy. With no randomized controlled trials, the optimal management approach for children with spinal astrocytomas remains unclear. The aim of this study was to conduct a systematic review and meta-analysis on pediatric spinal astrocytomas.METHODSThe authors performed a systematic review of the PubMed/MEDLINE electronic database to investigate the impact of histological grade and extent of resection on overall survival among patients with spinal cord astrocytomas. They retained publications in which the majority of reported cases included astrocytoma histology.RESULTSTwenty-nine previously published studies met the eligibility criteria, totaling 578 patients with spinal cord astrocytomas. The spinal level of intramedullary spinal cord tumors was predominantly cervical (53.8%), followed by thoracic (40.8%). Overall, resection was more common than biopsy, and GTR was slightly more commonly achieved than STR (39.7% vs 37.0%). The reported rates of GTR and STR rose markedly from 1984 to 2015. Patients with high-grade astrocytomas had markedly worse 5-year overall survival than patients with low-grade tumors. Patients receiving GTR may have better 5-year overall survival than those receiving STR.CONCLUSIONSThe authors describe trends in the management of pediatric spinal cord astrocytomas and suggest a benefit of GTR over STR for 5-year overall survival.

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P20-8 The impact of valproic acid on overall survival in patients with glioblastoma: A systematic review and meta-analysis

Annals of Oncology ◽

10.1016/j.annonc.2021.05.711 ◽

2021 ◽

Vol 32 ◽

pp. S340

Author(s):

Charlotte A. Jonatan ◽

Elizabeth Marcella ◽

Jeannette Tandiono ◽

Sharon Chen ◽

Felix Wijovi ◽

...

Keyword(s):

Systematic Review ◽

Valproic Acid ◽

Overall Survival ◽

Meta Analysis ◽

The Impact

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Management of low-grade glioma: a systematic review and meta-analysis

Neuro-Oncology Practice ◽

10.1093/nop/npy034 ◽

2018 ◽

Vol 6 (4) ◽

pp. 249-258 ◽

Cited By ~ 7

Author(s):

Timothy J Brown ◽

Daniela A Bota ◽

Martin J van Den Bent ◽

Paul D Brown ◽

Elizabeth Maher ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Progression Free Survival ◽

Low Grade Glioma ◽

World Health ◽

Subtotal Resection ◽

Low Grade ◽

Evidence Based ◽

Free Survival ◽

Low Grade Gliomas

Abstract Background Optimum management of low-grade gliomas remains controversial, and widespread practice variation exists. This evidence-based meta-analysis evaluates the association of extent of resection, radiation, and chemotherapy with mortality and progression-free survival at 2, 5, and 10 years in patients with low-grade glioma. Methods A quantitative systematic review was performed. Inclusion criteria included controlled trials of newly diagnosed low-grade (World Health Organization Grades I and II) gliomas in adults. Eligible studies were identified, assigned a level of evidence for every endpoint considered, and analyzed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The relative risk of mortality and of progression at 2, 5, and 10 years was calculated for patients undergoing resection (gross total, subtotal, or biopsy), radiation, or chemotherapy. Results Gross total resection was significantly associated with decreased mortality and likelihood of progression at all time points compared to subtotal resection. Early radiation was not associated with decreased mortality; however, progression-free survival was better at 5 years compared to patients receiving delayed or no radiation. Chemotherapy was associated with decreased mortality at 5 and 10 years in the high-quality literature. Progression-free survival was better at 5 and 10 years compared to patients who did not receive chemotherapy. In patients with isocitrate dehydrogenase 1 gene (IDH1) R132H mutations receiving chemotherapy, progression-free survival was better at 2 and 5 years than in patients with IDH1 wild-type gliomas. Conclusions Results from this review, the first to quantify differences in outcome associated with surgery, radiation, and chemotherapy in patients with low-grade gliomas, can be used to inform evidence-based management and future clinical trials.

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The Impact of Sarcopenia and Low Muscle Attenuation on Overall Survival in Epithelial Ovarian Cancer: A Systematic Review and Meta-analysis

Annals of Surgical Oncology ◽

10.1245/s10434-020-08382-0 ◽

2020 ◽

Vol 27 (9) ◽

pp. 3553-3564 ◽

Cited By ~ 1

Author(s):

Veronica McSharry ◽

Amy Mullee ◽

Lara McCann ◽

Ailin C. Rogers ◽

Mary McKiernan ◽

...

Keyword(s):

Systematic Review ◽

Ovarian Cancer ◽

Overall Survival ◽

Epithelial Ovarian Cancer ◽

Meta Analysis ◽

Muscle Attenuation ◽

The Impact

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Intraoperative Neuromonitoring in Patients with Intramedullary Spinal Cord Tumor: A Systematic Review, Meta-Analysis, and Case Series

World Neurosurgery ◽

10.1016/j.wneu.2019.01.007 ◽

2019 ◽

Vol 125 ◽

pp. 498-510.e2 ◽

Cited By ~ 3

Author(s):

Koen Rijs ◽

Markus Klimek ◽

Marjan Scheltens-de Boer ◽

Karla Biesheuvel ◽

Biswadjiet S. Harhangi

Keyword(s):

Systematic Review ◽

Spinal Cord ◽

Meta Analysis ◽

Spinal Cord Tumor ◽

Case Series ◽

Intraoperative Neuromonitoring ◽

Intramedullary Spinal Cord ◽

Intramedullary Spinal Cord Tumor

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Nonenhancing tumors of the spinal cord

Journal of Neurosurgery Spine ◽

10.3171/spi-07/09/10/403 ◽

2007 ◽

Vol 7 (4) ◽

pp. 403-407 ◽

Cited By ~ 20

Author(s):

J. Bradley White ◽

Gary M. Miller ◽

Kennith F. Layton ◽

William E. Krauss

Keyword(s):

Spinal Cord ◽

Common Finding ◽

Subtotal Resection ◽

Low Grade ◽

Spinal Cord Tumors ◽

Intramedullary Tumors ◽

Intramedullary Spinal Cord ◽

Tumor Invasiveness ◽

The Central Nervous System ◽

Tumor Types

Object Enhancement of pathological entities in the central nervous system is a common finding when the blood–brain barrier has been compromised. In the brain, the presence or absence of gadolinium enhancement is often an indicator of tumor invasiveness and/or grade. In the spinal cord, however, contrast enhancement has been shown in all tumor types, regardless of grade. In this study the authors explore the incidence of nonenhancing tumors of the spinal cord and the clinical course of patients with these lesions. Methods A retrospective analysis was conducted in which investigators examined the patterns of enhancement of histologically proven intramedullary spinal cord tumors that had been evaluated at the Mayo Clinic between 1998 and 2002. The tumors that did not enhance were the subject of this report. Results A total of 130 patients with intramedullary tumors were evaluated. Of those, 11 patients (9%) had tumors that did not enhance. Histologically, a majority of tumors were astrocytomas (eight low-grade and two high-grade lesions); one tumor was a subependymoma. Morphologically, most of the tumors were diffuse and none had associated cysts. Tumors spanned from two to seven levels and were located throughout the spinal cord (four cervical, three cervicothoracic, one thoracic, and three thoracolumbar). Biopsy procedures were performed in eight patients, subtotal resection was performed in two, and gross-total resection in one. After a mean follow-up period of 19 months, tumors remained stable in eight patients but progressed in three, two of whom died. Conclusions A number of intramedullary spinal cord tumors will not enhance after addition of contrast agents. The absence of enhancement does not imply the absence of tumor.

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