Impact of extent of resection and adjuvant therapy in diffuse gliomas of the spine.
Publication/Presentation Date
7-1-2023
Abstract
BACKGROUND CONTENT: Diffuse gliomas of the spine (DGS)-consisting of intradural intramedullary glioblastoma, astrocytoma, and oligodendroglioma-are exceedingly rare tumors that account for about 2% of primary spinal cord tumors. Much is unknown about their optimal treatment regimen due to a relative lack of clinical outcome data.
PURPOSE: To provide an updated analysis on treatment and outcomes in DGS.
STUDY DESIGN/SETTING: Observational cohort study using The National Cancer Database (NCDB), a multicenter prospectively collected oncology outcomes database. A systematic literature review was also performed to compare the resulting data to previous series.
PATIENT SAMPLE: Patients with histologically confirmed DGS from 2004 to 2018.
OUTCOME MEASURES: Long-term overall survival and short-term 30/90-day postsurgical mortality, 30-day readmission, and prolonged hospital length of stay.
METHODS: Impact of extent of resection and adjuvant therapy on overall survival was evaluated using Kaplan-Meier estimates and multivariable Cox proportional hazards regression. Univariate and multivariate logistic regression was used to analyze covariables and their prognostic impact on short-term surgical outcomes.
RESULTS: Of the 747 cases that met inclusion criteria, there were 439 astrocytomas, 14 oligodendrogliomas, and 208 glioblastomas. Sixty percent (n=442) of patients received radiation, and 45% (n=324) received chemotherapy. Tumor histology significantly impacted survival; glioblastoma had the poorest survival (median survival time [MS]: 12.3 months), followed by astrocytoma (MS: 70.8 months) and oligodendroglioma (MS: 71.6 months) (p
CONCLUSIONS: There remains a paucity of data regarding treatment paradigms and outcomes for DGS. Our analysis, the largest to date, demonstrates that GTR and adjuvant therapy independently improve survival for certain high-grade subgroups of DGS. This best-available data informs optimal management for such patients.
Volume
23
Issue
7
First Page
1015
Last Page
1027
ISSN
1878-1632
Published In/Presented At
Chalif, E. J., Foster, C., Sack, K., Patrick, H., Mozaffari, K., & Rosner, M. (2023). Impact of extent of resection and adjuvant therapy in diffuse gliomas of the spine. The spine journal : official journal of the North American Spine Society, 23(7), 1015–1027. https://doi.org/10.1016/j.spinee.2023.02.010
Disciplines
Medicine and Health Sciences
PubMedID
36804437
Department(s)
Fellows and Residents
Document Type
Article
