Oral Posters: Values and Outcomes in Spine Surgery
Presented by: S. Yi - View Audio/Video Presentation (Members Only)
S. Yi(1), D.S. KIM(1), J. Kang(1), D.H. Chun(1), D. Kim(1), D.A. Shin(1), K.N. Kim(1), D.H. Yoon(1)
(1) Spine and Spinal Cord Institute, Yonsei University, College of Medicine, Neurosurgery, Seoul, Korea, Republic of
Purpose: Accounting for less than 0.2% of all glioblastomas, high grade gliomas of the spinal cord are very rare. The optimal management of spinal cord gliomas remains controversial and no standard treatment protocol has been established. We discuss our approach to managing patients with primary spinal cord glioblastoma and review surgical and clinical outcomes, prognostic factors. This study is the largest series of spinal cord glioblastoma in single institution and analyzed prognostic factors and patient's outcome after surgery.
Methods: We retrospectively reviewed the data from all patients on whom we performed spinal cord tumor removal between 2003 and 2016. 21 patients were pathologically confirmed to have primary spinal cord glioblastoma. Surgical extent and disease progression were confirmed by the surgeon based on operative findings, postoperative MRI, and outpatient department (OPD) follow-up. Treatment modality including radiotherapy and chemotherapy, survival analysis, duration until tumor recurrence, pattern of recurrence, cause of death, immunohistochemical and molecular profiles were analyzed for prognostic factor.
Results: Among 21 patients, male to female ratio was 16:5, average age was 37.5 years old (range from 12 to 73 years) at diagnosis. All patients presented with motor or sensory dysfunction at diagnosis. 13 patients died until July 2016. All patient underwent radiotherapy (45Gy to 54Gy) and chemotherapy using Temozolomide (5 to 7 cycles). All tumors were present in the cervical (N=6, 28.6%), thoracic (N=11, 52.4%), thoraco-lumbar (N=3, 14.3%), lumbar (N=4.8%) spine, spanning an average of 2.8 levels. Gross total resection was achieved in 8 patient (38.1%), subtotal removal 5 (23.8%), partial removal 5 (23.8%), biopsy 3 (14.3%) was done. Recurrence was shown in 12 patients until July 2016, average recurrence period was 25.1 months. The pattern of recurrence was distant spinal cord seeding in 2 cases, leptomeningeal seeding and brain metastasis in 2 cases, 8 cases recurred at primary tumor site. Immunohistochemical stain results in all patients' IDH1 mutation negative, MGMT methylation showed unmethylation in 12/13patients and methylation 1/13 patients, H3.3 K27M was positive in 5/6 and negative 1/6 patients. Survival analysis revealed median survival as 28.9±4.6 month (range from 5.7 to 55.1 months) and no statistically prognostic factor (Extent of surgery, Radiotherapy, Chemotherapy, Age, Sex and pathological findings). Male showed longer tendency in survival than female (29.7 vs 23.3 years in average, p=0.364).
Conclusions: The surgical outcome of patients diagnosed with spinal cord glioblastomas remains poor. Though no statistically significant prognostic factor was found, early operative treatment and postoperative adjuvant radiochemotherapy should be performed for spinal cord glioblastoma for favorable clinical outcome. To establish optimal treatment strategy, multicenter, nation-wide series of registry would be required in the future.
Keywords: Glioblastoma, Spinal cord tumor, Intramedullary tumor, Outcome, Radiation therapy, immunohistochemical stain, prognosis, survival analysis