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Erschienen in: Strahlentherapie und Onkologie 3/2016

01.03.2016 | Original Article

Radiotherapy of spinal cord gliomas

A retrospective mono-institutional analysis

verfasst von: Dr. med. Stefanie Corradini, MD, Indrawati Hadi, MD, Vinzent Hankel, MD, Lorenz Ertl, MD, MSc, Ute Ganswindt, MD, Claus Belka, MD, Maximilian Niyazi, MD, MSc

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 3/2016

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Abstract

Background

Due to the rarity of spinal cord gliomas, no consensus has been reached regarding the optimal treatment strategy. The aim of the present retrospective study was to identify patient and tumor characteristics and to evaluate the effectiveness of radiotherapy within this setting.

Patients and methods

Patients diagnosed with spinal cord gliomas between 2003 and 2013 and treated at the Department of Radiation Oncology, University of Munich, were retrospectively analyzed. Overall survival was estimated with the Kaplan–Meier method and univariate analysis was performed by log-rank testing.

Results

A total of 16 patients were identified. The cohort consisted of seven primary spinal cord gliomas and eight cases of metastases of cerebral gliomas. Median follow-up was 42 months and median total radiation dose was 45.0 Gy. In all, 62.5 % of patients received a simultaneous chemotherapy with temozolomide. The median overall survival was 6 months (95% CI: 0–27.5 months). Surgical resection of the tumor was a significant predictor of improved survival, compared with radiotherapy alone (p = 0.001). Patients with the diagnosis of a primary spinal cord glioma survived significantly longer than those presenting with a metastatic deposit from a cerebral glioma (p < 0.001). A statistically significant dose–response relationship at dose levels of ≥ 45 Gy vs. < 45 Gy could be derived (p < 0.001). Simultaneous chemotherapy did not influence survival outcome.

Conclusion

Despite the aggressive treatment in the present study, the prognosis for spinal cord gliomas was still poor, with a median overall survival of 6 months. To the best of our knowledge, this is the largest study reporting the results of simultaneous chemoradiation in spinal cord gliomas. A combined chemoradiation treatment seems feasible and can be considered as a new treatment option in the management of spinal cord gliomas.
Literatur
2.
Zurück zum Zitat Rodrigues GB, Waldron JN, Wong CS et al (2000) A retrospective analysis of 52 cases of spinal cord glioma managed with radiation therapy. Int J Radiat Oncol Biol Phys 48:837–842CrossRefPubMed Rodrigues GB, Waldron JN, Wong CS et al (2000) A retrospective analysis of 52 cases of spinal cord glioma managed with radiation therapy. Int J Radiat Oncol Biol Phys 48:837–842CrossRefPubMed
3.
Zurück zum Zitat Nowak-Sadzikowska J, Gliński B (2002) The value of postoperative radiotherapy of primary spinal cord glioma. Rep Pract Oncol Radiother 7:139–147CrossRef Nowak-Sadzikowska J, Gliński B (2002) The value of postoperative radiotherapy of primary spinal cord glioma. Rep Pract Oncol Radiother 7:139–147CrossRef
4.
Zurück zum Zitat Abdel-Wahab M, Etuk B, Palermo J et al (2006) Spinal cord gliomas: a multi-institutional retrospective analysis. Int J Radiat Oncol Biol Phys 64:1060–1071CrossRefPubMed Abdel-Wahab M, Etuk B, Palermo J et al (2006) Spinal cord gliomas: a multi-institutional retrospective analysis. Int J Radiat Oncol Biol Phys 64:1060–1071CrossRefPubMed
5.
Zurück zum Zitat Zorlu F, Ozyigit G, Gurkaynak M et al (2005) Postoperative radiotherapy results in primary spinal cord astrocytomas. Radiother Oncol 74:45–48CrossRefPubMed Zorlu F, Ozyigit G, Gurkaynak M et al (2005) Postoperative radiotherapy results in primary spinal cord astrocytomas. Radiother Oncol 74:45–48CrossRefPubMed
6.
Zurück zum Zitat Shirato H, Kamada T, Hida K et al (1995) The role of radiotherapy in the management of spinal cord glioma. Int J Radiat Oncol Biol Phys 33:323–328CrossRefPubMed Shirato H, Kamada T, Hida K et al (1995) The role of radiotherapy in the management of spinal cord glioma. Int J Radiat Oncol Biol Phys 33:323–328CrossRefPubMed
7.
Zurück zum Zitat Kahn J, Loeffler JS, Niemierko A et al (2011) Long-term outcomes of patients with spinal cord gliomas treated by modern conformal radiation techniques. Int J Radiat Oncol Biol Phys 81:232–238CrossRefPubMed Kahn J, Loeffler JS, Niemierko A et al (2011) Long-term outcomes of patients with spinal cord gliomas treated by modern conformal radiation techniques. Int J Radiat Oncol Biol Phys 81:232–238CrossRefPubMed
8.
Zurück zum Zitat Robinson CG, Prayson RA, Hahn JF et al (2005) Long-term survival and functional status of patients with low-grade astrocytoma of spinal cord. Int J Radiat Oncol Biol Phys 63:91–100CrossRefPubMed Robinson CG, Prayson RA, Hahn JF et al (2005) Long-term survival and functional status of patients with low-grade astrocytoma of spinal cord. Int J Radiat Oncol Biol Phys 63:91–100CrossRefPubMed
9.
Zurück zum Zitat Stupp R, Hegi ME, Mason WP et al (2009) Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol 10:459–466CrossRefPubMed Stupp R, Hegi ME, Mason WP et al (2009) Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol 10:459–466CrossRefPubMed
10.
Zurück zum Zitat Karim AB, Maat B, Hatlevoll R et al (1996) A randomized trial on dose-response in radiation therapy of low-grade cerebral glioma: European Organization for Research and Treatment of Cancer (EORTC) Study 22844. Int J Radiat Oncol Biol Phys 36:549–556CrossRefPubMed Karim AB, Maat B, Hatlevoll R et al (1996) A randomized trial on dose-response in radiation therapy of low-grade cerebral glioma: European Organization for Research and Treatment of Cancer (EORTC) Study 22844. Int J Radiat Oncol Biol Phys 36:549–556CrossRefPubMed
11.
Zurück zum Zitat Balducci M, Fiorentino A, De Bonis P et al (2013) Concurrent and adjuvant temozolomide-based chemoradiotherapy schedules for glioblastoma. Hypotheses based on two prospective phase II trials. Strahlenther Onkol 189:926–931CrossRefPubMed Balducci M, Fiorentino A, De Bonis P et al (2013) Concurrent and adjuvant temozolomide-based chemoradiotherapy schedules for glioblastoma. Hypotheses based on two prospective phase II trials. Strahlenther Onkol 189:926–931CrossRefPubMed
12.
Zurück zum Zitat Lawton CD, Nagasawa DT, Yang I et al (2012) Leptomeningeal spinal metastases from glioblastoma multiforme: treatment and management of an uncommon manifestation of disease. J Neurosurg Spine 17:438–448CrossRefPubMed Lawton CD, Nagasawa DT, Yang I et al (2012) Leptomeningeal spinal metastases from glioblastoma multiforme: treatment and management of an uncommon manifestation of disease. J Neurosurg Spine 17:438–448CrossRefPubMed
13.
Zurück zum Zitat Niyazi M, Schwarz SB, Suchorska B et al (2012) Radiotherapy with and without temozolomide in elderly patients with glioblastoma. Strahlenther Onkol 188:154–159CrossRefPubMed Niyazi M, Schwarz SB, Suchorska B et al (2012) Radiotherapy with and without temozolomide in elderly patients with glioblastoma. Strahlenther Onkol 188:154–159CrossRefPubMed
14.
Zurück zum Zitat Flieger M, Ganswindt U, Schwarz SB et al (2014) Re-irradiation and bevacizumab in recurrent high-grade glioma: an effective treatment option. J Neurooncol 117:337–345CrossRefPubMed Flieger M, Ganswindt U, Schwarz SB et al (2014) Re-irradiation and bevacizumab in recurrent high-grade glioma: an effective treatment option. J Neurooncol 117:337–345CrossRefPubMed
15.
16.
Zurück zum Zitat Chinot OL, Wick W, Mason W et al (2014) Bevacizumab plus radiotherapy–temozolomide for newly diagnosed glioblastoma. N Engl J Med 370:709–722CrossRefPubMed Chinot OL, Wick W, Mason W et al (2014) Bevacizumab plus radiotherapy–temozolomide for newly diagnosed glioblastoma. N Engl J Med 370:709–722CrossRefPubMed
17.
Zurück zum Zitat Niyazi M, Jansen NL, Rottler M et al (2014) Recurrence pattern analysis after re-irradiation with bevacizumab in recurrent malignant glioma patients. Radiat Oncol 9:299PubMedCentralCrossRefPubMed Niyazi M, Jansen NL, Rottler M et al (2014) Recurrence pattern analysis after re-irradiation with bevacizumab in recurrent malignant glioma patients. Radiat Oncol 9:299PubMedCentralCrossRefPubMed
18.
Zurück zum Zitat Fietkau R, Putz F, Lahmer G et al (2013) Can MGMT promoter methylation status be used as a prognostic and predictive marker for glioblastoma multiforme at the present time? A word of caution. Strahlenther Onkol 189:993–995CrossRefPubMed Fietkau R, Putz F, Lahmer G et al (2013) Can MGMT promoter methylation status be used as a prognostic and predictive marker for glioblastoma multiforme at the present time? A word of caution. Strahlenther Onkol 189:993–995CrossRefPubMed
19.
Zurück zum Zitat Chamberlain MC, Tredway TL (2011) Adult primary intradural spinal cord tumors: a review. Curr Neurol Neurosci Rep 11:320–328CrossRefPubMed Chamberlain MC, Tredway TL (2011) Adult primary intradural spinal cord tumors: a review. Curr Neurol Neurosci Rep 11:320–328CrossRefPubMed
20.
Zurück zum Zitat Raco A, Esposito V, Lenzi J et al (2005) Long-term follow-up of intramedullary spinal cord tumors: a series of 202 cases. Neurosurgery 56:972–981 (discussion 972–981)PubMed Raco A, Esposito V, Lenzi J et al (2005) Long-term follow-up of intramedullary spinal cord tumors: a series of 202 cases. Neurosurgery 56:972–981 (discussion 972–981)PubMed
21.
Zurück zum Zitat Mcgirt MJ, Goldstein IM, Chaichana KL et al (2008) Extent of surgical resection of malignant astrocytomas of the spinal cord: outcome analysis of 35 patients. Neurosurgery 63:55–60 (discussion 60–51)CrossRefPubMed Mcgirt MJ, Goldstein IM, Chaichana KL et al (2008) Extent of surgical resection of malignant astrocytomas of the spinal cord: outcome analysis of 35 patients. Neurosurgery 63:55–60 (discussion 60–51)CrossRefPubMed
22.
Zurück zum Zitat Sandler HM, Papadopoulos SM, Thornton AF Jr et al (1992) Spinal cord astrocytomas: results of therapy. Neurosurgery 30:490–493CrossRefPubMed Sandler HM, Papadopoulos SM, Thornton AF Jr et al (1992) Spinal cord astrocytomas: results of therapy. Neurosurgery 30:490–493CrossRefPubMed
23.
Zurück zum Zitat Minehan KJ, Brown PD, Scheithauer BW et al (2009) Prognosis and treatment of spinal cord astrocytoma. Int J Radiat Oncol Biol Phys 73:727–733CrossRefPubMed Minehan KJ, Brown PD, Scheithauer BW et al (2009) Prognosis and treatment of spinal cord astrocytoma. Int J Radiat Oncol Biol Phys 73:727–733CrossRefPubMed
24.
Zurück zum Zitat Isaacson SR (2000) Radiation therapy and the management of intramedullary spinal cord tumors. J Neurooncol 47:231–238CrossRefPubMed Isaacson SR (2000) Radiation therapy and the management of intramedullary spinal cord tumors. J Neurooncol 47:231–238CrossRefPubMed
25.
Zurück zum Zitat Garcia DM (1985) Primary spinal cord tumors treated with surgery and postoperative irradiation. Int J Radiat Oncol Biol Phys 11:1933–1939 Garcia DM (1985) Primary spinal cord tumors treated with surgery and postoperative irradiation. Int J Radiat Oncol Biol Phys 11:1933–1939
26.
Zurück zum Zitat Marks LB, Yorke ED, Jackson A et al (2010) Use of normal tissue complication probability models in the clinic. Int J Radiat Oncol Biol Phys 76:10–19PubMedCentralCrossRefPubMed Marks LB, Yorke ED, Jackson A et al (2010) Use of normal tissue complication probability models in the clinic. Int J Radiat Oncol Biol Phys 76:10–19PubMedCentralCrossRefPubMed
27.
Zurück zum Zitat Emami B, Lyman J, Brown A et al (1991) Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 21:109–122CrossRefPubMed Emami B, Lyman J, Brown A et al (1991) Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 21:109–122CrossRefPubMed
28.
Zurück zum Zitat Kirkpatrick JP, Van Der Kogel AJ, Schultheiss TE (2010) Radiation dose–volume effects in the spinal cord. Int J Radiat Oncol Biol Phys 76:42–49CrossRefPubMed Kirkpatrick JP, Van Der Kogel AJ, Schultheiss TE (2010) Radiation dose–volume effects in the spinal cord. Int J Radiat Oncol Biol Phys 76:42–49CrossRefPubMed
29.
Zurück zum Zitat Linstadt DE, Wara WM, Leibel SA et al (1989) Postoperative radiotherapy of primary spinal cord tumors. Int J Radiat Oncol Biol Phys 16:1397–1403CrossRefPubMed Linstadt DE, Wara WM, Leibel SA et al (1989) Postoperative radiotherapy of primary spinal cord tumors. Int J Radiat Oncol Biol Phys 16:1397–1403CrossRefPubMed
30.
Zurück zum Zitat Shaw EG, Evans RG, Scheithauer BW et al (1986) Radiotherapeutic management of adult intraspinal ependymomas. Int J Radiat Oncol Biol Phys 12:323–327CrossRefPubMed Shaw EG, Evans RG, Scheithauer BW et al (1986) Radiotherapeutic management of adult intraspinal ependymomas. Int J Radiat Oncol Biol Phys 12:323–327CrossRefPubMed
31.
Zurück zum Zitat Muller K, Schlamann A, Guckenberger M et al (2014) Craniospinal irradiation with concurrent temozolomide for primary metastatic pediatric high-grade or diffuse intrinsic pontine gliomas. A first report from the GPOH-HIT-HGG Study Group. Strahlenther Onkol 190:377–381CrossRefPubMed Muller K, Schlamann A, Guckenberger M et al (2014) Craniospinal irradiation with concurrent temozolomide for primary metastatic pediatric high-grade or diffuse intrinsic pontine gliomas. A first report from the GPOH-HIT-HGG Study Group. Strahlenther Onkol 190:377–381CrossRefPubMed
32.
Zurück zum Zitat Muller K, Schlamann A, Seidel C et al (2013) Craniospinal irradiation with concurrent temozolomide and nimotuzumab in a child with primary metastatic diffuse intrinsic pontine glioma. A compassionate use treatment. Strahlenther Onkol 189:693–696CrossRefPubMed Muller K, Schlamann A, Seidel C et al (2013) Craniospinal irradiation with concurrent temozolomide and nimotuzumab in a child with primary metastatic diffuse intrinsic pontine glioma. A compassionate use treatment. Strahlenther Onkol 189:693–696CrossRefPubMed
33.
Zurück zum Zitat Cairncross G, Wang M, Shaw E et al (2013) Phase III trial of chemoradiotherapy for anaplastic oligodendroglioma: long-term results of RTOG 9402. J Clin Oncol 31:337–343PubMedCentralCrossRefPubMed Cairncross G, Wang M, Shaw E et al (2013) Phase III trial of chemoradiotherapy for anaplastic oligodendroglioma: long-term results of RTOG 9402. J Clin Oncol 31:337–343PubMedCentralCrossRefPubMed
34.
Zurück zum Zitat Chamberlain MC (2008) Temozolomide for recurrent low-grade spinal cord gliomas in adults. Cancer 113:1019–1024CrossRefPubMed Chamberlain MC (2008) Temozolomide for recurrent low-grade spinal cord gliomas in adults. Cancer 113:1019–1024CrossRefPubMed
35.
Zurück zum Zitat Kaley TJ, Mondesire-Crump I, Gavrilovic IT (2012) Temozolomide or bevacizumab for spinal cord high-grade gliomas. J Neurooncol 109:385–389CrossRefPubMed Kaley TJ, Mondesire-Crump I, Gavrilovic IT (2012) Temozolomide or bevacizumab for spinal cord high-grade gliomas. J Neurooncol 109:385–389CrossRefPubMed
36.
Zurück zum Zitat Chamberlain MC, Johnston SK (2011) Recurrent spinal cord glioblastoma: salvage therapy with bevacizumab. J Neurooncol 102:427–432CrossRefPubMed Chamberlain MC, Johnston SK (2011) Recurrent spinal cord glioblastoma: salvage therapy with bevacizumab. J Neurooncol 102:427–432CrossRefPubMed
37.
Zurück zum Zitat Tseng HM, Kuo LT, Lien HC et al (2010) Prolonged survival of a patient with cervical intramedullary glioblastoma multiforme treated with total resection, radiation therapy, and temozolomide. Anticancer Drugs 21:963–967CrossRefPubMed Tseng HM, Kuo LT, Lien HC et al (2010) Prolonged survival of a patient with cervical intramedullary glioblastoma multiforme treated with total resection, radiation therapy, and temozolomide. Anticancer Drugs 21:963–967CrossRefPubMed
38.
Zurück zum Zitat Kim WH, Yoon SH, Kim CY et al (2011) Temozolomide for malignant primary spinal cord glioma: an experience of six cases and a literature review. J Neurooncol 101:247–254CrossRefPubMed Kim WH, Yoon SH, Kim CY et al (2011) Temozolomide for malignant primary spinal cord glioma: an experience of six cases and a literature review. J Neurooncol 101:247–254CrossRefPubMed
Metadaten
Titel
Radiotherapy of spinal cord gliomas
A retrospective mono-institutional analysis
verfasst von
Dr. med. Stefanie Corradini, MD
Indrawati Hadi, MD
Vinzent Hankel, MD
Lorenz Ertl, MD, MSc
Ute Ganswindt, MD
Claus Belka, MD
Maximilian Niyazi, MD, MSc
Publikationsdatum
01.03.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
Strahlentherapie und Onkologie / Ausgabe 3/2016
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-015-0917-0

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