MANAGEMENT OF SPINAL ASTROCYTOMA WITH CONSERVATIVE SURGERY AND RADIOTHERAPY

Twenty-seven patients with histologically verified spinal astrocytoma were treated at the Royal Marsden Hospital with postoperative radiothe rapy. All patients had previous surgery; 10 had partial resection and 17 biopsy alone. All patients received involved field radiotherapy to a median dose of 50 Gy in 33 fractions. Overall 5- and 10-year surviva l was 59 and 52%, and progression free survival was 38 and 26% at 5 an d 10 years, respectively, at a median follow-up of 6.5 years. Followin g radiotherapy, eight patients showed functional improvement, 15 were unchanged and two deteriorated. Sixteen patients relapsed, eleven at t he primary site and five elsewhere in the CNS. Low grade histology, fe male gender and the presence of intramedullary cysts were favourable p rognostic factors for survival on univariate analysis. The extent of s urgery was not a significant predictor of survival. It is not possible to define the precise role of radiotherapy. However, all patients had residual tumour prior to irradiation, and 53% of low grade and 33% of high grade gliomas remained controlled locally at 3 years with stabil ization or improvement in neurological function in all but two patient s. This suggests that radiotherapy may result in temporary disease con trol analogous to cerebral gliomas.