Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Korea (Republic of).
Department of Neurosurgery, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea (Republic of).
Strahlenther Onkol. 2019 Feb;195(2):164-174. doi: 10.1007/s00066-018-1366-3. Epub 2018 Sep 10.
Spinal cord gliomas are rare, and there is no consensus on the optimal radiotherapy (RT) regimen. Herein, we investigated therapeutic outcomes in spinal cord gliomas to obtain clues for the optimal RT regimen.
We assessed 45 patients who received RT for primary spinal cord non-ependymoma gliomas between 2005 and 2017: 37 (82%) received postoperative RT, 6 (13%) underwent definitive RT without surgery, and 2 (5%) received salvage RT for recurrent tumors. Craniospinal irradiation (CSI; median, 40 Gy) was administered in 4 patients with seeding at diagnosis; all other patients received local RT only (median, 50.4 Gy).
In all 23 failures occurred (20 in patients without initial seeding +3 in patients with initial seeding and CSI; median follow-up, 33 months). The 2‑year overall survival and progression-free survival rates were 74 and 54%, respectively. Overall, 13 (32%) new seeding events outside the local RT field developed either first or subsequently. Tumor grade was significantly associated with survival endpoints (p = 0.009, 0.028) and overall seeding rates (p = 0.042). In grade II tumors, seeding developed in 23%, with a dismal prognosis (median, 10 months after RT). In grade III tumors, seeding developed in 45% with diverse prognosis. In grade IV tumors, seeding developed in 45%. The survival of patients with newly developed seeding was significantly worse than the others (2-year 50%, p < 0.001).
To encompass a considerable rate of progressive disease seeding, aggressive treatment such as pre-emptive application of CSI needs to be considered for high-grade spinal cord gliomas with adverse features. Prophylactic CSI could be an option for survival prolongation and requires prospective validation.
脊髓神经胶质瘤较为罕见，目前对于其最佳放疗（RT）方案尚无共识。本研究旨在通过研究脊髓神经胶质瘤的治疗结果，为最佳 RT 方案提供线索。
我们评估了 2005 年至 2017 年间接受 RT 治疗的 45 例原发性脊髓非室管膜瘤神经胶质瘤患者：37 例（82%）接受术后 RT，6 例（13%）未行手术直接接受根治性 RT，2 例（5%）接受复发性肿瘤挽救性 RT。4 例诊断时存在播散的患者接受了颅脊髓照射（CSI；中位剂量 40 Gy）；其余所有患者仅接受局部 RT（中位剂量 50.4 Gy）。
所有患者共发生 23 例失败（未行初始播散的患者中有 20 例+初始播散且行 CSI 的患者中有 3 例；中位随访时间 33 个月）。2 年总生存率和无进展生存率分别为 74%和 54%。总体而言，13 例（32%）新的播散事件发生在局部 RT 野之外，无论首次还是随后发生。肿瘤分级与生存终点显著相关（p=0.009，0.028）和总体播散率（p=0.042）。在 II 级肿瘤中，播散发生率为 23%，预后较差（RT 后中位时间 10 个月）。在 III 级肿瘤中，播散发生率为 45%，预后不一。在 IV 级肿瘤中，播散发生率为 45%。发生新发播散的患者生存明显更差（2 年生存率 50%，p<0.001）。
对于高级别伴不良特征的脊髓神经胶质瘤，为涵盖相当比例的进行性疾病播散，需要考虑积极治疗，如预防性应用 CSI。预防性 CSI 可能是延长生存时间的一种选择，需要前瞻性验证。
