Conservative Surgery and Radiotherapy for Adult Spinal Astrocytoma: Balanced Strategy for Favorable Outcome

Abstract

Objective: Spinal cord astrocytomas are considered diffuse infiltrating tumors. The optimal treatment of these lesions has been controversial. The conventional management with partial resection followed by radiotherapy remains. In order to evaluate this traditional and famous strategy, the authors retrospectively review a series of ten consecutive adult patients with spinal cord astrocytoma treated with conservative surgery and radiotherapy. Methods Results: A retrospective analysis of ten adult patients (4 men and 6 women) with spinal cord astorcytoma. The mean age was 33 years. Cervical cord was involved in 2 patients, cervicothoracic in 3, thoracic in 5. Seven patients had low grade astrocytoma and 3 high grade (2 anaplastic, 1 gliobastoma).Surgery was subtotal excision in 1 patient, partial excision in 3 and biopsy in 6 patients. All patients received postoperative radiotherapy to a median dose of 45 Gy in 25 fractions over 5 weeks. The follow-up period ranged from 7 to 48 months. Postradiotherapy, local tumor control was achieved in 7 cases ( 6 low gade, 1 high grade) despite incomplete or no resection. Three patients died, one paraplegic patient of pneumonia, and two patients with high grade astrocytoma from tumor progression or dissemination. Conclusion: There is no significant effect of the extent of resection on local relapse. We believe that conservative surgery and radiotherapy provide a balanced strategy in the treatment of adult spinal astrocytoma to maintain neurological outcome and prevent tumor recurrence.