CONSERVATIVE SURGERY AND RADIOTHERAPY IN THE TREATMENT OF SPINAL-CORDASTROCYTOMA

Spinal cord astrocytomas are rare neoplasms, and optimal treatment gui delines are undefined. 23 patients with spinal cord astrocytomas were treated between 1984 and 1993 with conservative surgery and postoperat ive radiotherapy. The mean age was 31 years. Twelve patients were male and eleven female. All patients presented with neurologic deficits. C ervical cord was involved in five patients, cervicothoracic in four, t horacic in eight and thoracolumbar in six. Five patients had intramedu llary cysts. Fifteen patients had low grade tumors and six high grade. Surgery was near total excision in three patients, partial excision i n ten and biopsy in ten patients. All patients received postoperative radiotherapy to a median dose of 45 Gy in 25 fractions over 5 weeks. T he median followup was 51 months (range 7-143 months). At 6 months pos t radiotherapy, twelve patients had improvement of neurologic status, nine had stable status, and two deteriorated. The actuarial overall su rvival was 55% at 5 years and 39% at 10 years. The actuarial progressi on free survival probability was 75% at 5 years and 55% at 10 years. F ive patients had local failure and two failed at distant sites. Twelve patients died, six due to progressive disease, five due to complicati ons of paraplegia and one patient of unrelated causes. Tumor grade was a significant prognostic factor for overall survival. 5 year overall survival was 79% for low grade tumors. No patient with high grade tumo r survived more than 2 years and the median survival was 10 months. Lo w grade, female sex and presence of intramedullary cysts were associat ed with significantly improved progression free survival. Conservative surgery followed by radiotherapy appears to have a role in achieving tumor control and neurologic recovery in patients with low grade astro cytomas of the spinal cord. Treatment results of high grade tumors rem ain poor and new therapeutic strategies need to be studied.