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Radiotherapy of spinal cord gliomas

A retrospective mono-institutional analysis

Strahlentherapie bei spinalen Gliomen

Eine retrospektive monoinstitutionelle Analyse

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Abstract

Background

Due to the rarity of spinal cord gliomas, no consensus has been reached regarding the optimal treatment strategy. The aim of the present retrospective study was to identify patient and tumor characteristics and to evaluate the effectiveness of radiotherapy within this setting.

Patients and methods

Patients diagnosed with spinal cord gliomas between 2003 and 2013 and treated at the Department of Radiation Oncology, University of Munich, were retrospectively analyzed. Overall survival was estimated with the Kaplan–Meier method and univariate analysis was performed by log-rank testing.

Results

A total of 16 patients were identified. The cohort consisted of seven primary spinal cord gliomas and eight cases of metastases of cerebral gliomas. Median follow-up was 42 months and median total radiation dose was 45.0 Gy. In all, 62.5 % of patients received a simultaneous chemotherapy with temozolomide. The median overall survival was 6 months (95% CI: 0–27.5 months). Surgical resection of the tumor was a significant predictor of improved survival, compared with radiotherapy alone (p = 0.001). Patients with the diagnosis of a primary spinal cord glioma survived significantly longer than those presenting with a metastatic deposit from a cerebral glioma (p < 0.001). A statistically significant dose–response relationship at dose levels of ≥ 45 Gy vs. < 45 Gy could be derived (p < 0.001). Simultaneous chemotherapy did not influence survival outcome.

Conclusion

Despite the aggressive treatment in the present study, the prognosis for spinal cord gliomas was still poor, with a median overall survival of 6 months. To the best of our knowledge, this is the largest study reporting the results of simultaneous chemoradiation in spinal cord gliomas. A combined chemoradiation treatment seems feasible and can be considered as a new treatment option in the management of spinal cord gliomas.

Zusammenfassung

Hintergrund

Das spinale Gliom stellt eine äußerst seltene Entität dar. Aktuell besteht daher kein Konsensus über die optimale Behandlungsstrategie. Ziel dieser retrospektiven Studie war es, die patienten- sowie tumorbezogenen Charakteristika auszuwerten und den Einsatz sowie die Rolle der Strahlentherapie (RT) bei der Behandlung von spinalen Gliomen zu untersuchen.

Patienten und Methoden

Es wurden retrospektiv die Daten von allen Patienten mit spinalen Gliomen untersucht, welche von 2003 bis 2013 an der Klinik für Strahlentherapie der LMU München behandelt wurden. Es erfolgte die Auswertung der patienten- sowie tumor- und therapiebezogenen Charakteristika. Das Gesamtüberleben (OS) wurde nach Kaplan-Meier geschätzt. Univariate Analysen wurden mittels Log-Rank-Test durchgeführt.

Ergebnisse

Die Daten von 16 Patienten wurden analysiert. Darunter waren sieben primäre spinale Gliome und acht Abtropfmetastasen intrakranieller Gliome. Das mediane Follow-up betrug 42 Monate. Alle Patienten erhielten eine RT mit einer medianen Gesamtdosis von 45,0 Gy. In 62,5 % erfolgte eine simultane Radiochemotherapie mit Temozolomid. Das mediane OS für die gesamte Kohorte lag bei 6 Monaten (95 %-KI 0,0–27,5). Patienten mit der Diagnose eines primären spinalen Glioms hatten ein signifikant besseres OS als Patienten mit zerebralen Abtropfmetastasen (p < 0,001). Ebenso war eine Tumorresektion mit einem signifikanten Überlebensvorteil assoziiert (p = 0,001). Bezüglich der RT zeigte sich eine Dosis-Wirkungs-Beziehung ab einer Dosis von ≥ 45 Gy, welche mit einem verbesserten OS im Vergleich zu einer Bestrahlungsdosis von < 45 Gy korrelierte (p < 0,001). Die simultane Chemotherapie hatte keinen Einfluss auf das OS.

Schlussfolgerung

Trotz der Fortschritte im Bereich der multimodalen Therapie ist die Prognose spinaler Gliome mit einem medianen OS von nur 6 Monaten immer noch schlecht. Obwohl die Aussagekraft der Ergebnisse durch die relativ kleine Anzahl an Patienten begrenzt ist, stellt diese Studie einen wichtigen Beitrag zur spärlichen Datenlage dar. Die vorliegenden Studienergebnisse sind außerdem eine der größten Fallsammlungen zur simultanen Radiochemotherapie bei spinalen Gliomen. Eine kombinierte Radiochemotherapie scheint machbar und kann als neue Behandlungsoption bei spinalen Gliomen in Erwägung gezogen werden.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Munich, Marchioninistr. 15, 81377, Munich, Germany

    Stefanie Corradini MD, Indrawati Hadi MD, Ute Ganswindt MD, Claus Belka MD & Maximilian Niyazi MD, MSc

  2. Department of Radiation Oncology, Marienhospital Stuttgart, Böheimstraße 37, 70199, Stuttgart, Germany

    Vinzent Hankel MD

  3. Department of Radiology, Neuroradiology, and Nuclear Medicine, Städtisches Klinikum München Harlaching, Sanatoriumsplatz 2, 81545, Munich, Germany

    Lorenz Ertl MD, MSc

  4. Department of Neuroradiology, University of Munich, Marchioninistr. 15, 81377, Munich, Germany

    Lorenz Ertl MD, MSc

Authors
  1. Stefanie Corradini MD
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  2. Indrawati Hadi MD
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  3. Vinzent Hankel MD
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  4. Lorenz Ertl MD, MSc
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  5. Ute Ganswindt MD
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  6. Claus Belka MD
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  7. Maximilian Niyazi MD, MSc
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Corresponding author

Correspondence to Stefanie Corradini MD.

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Conflict of interest

S. Corradini, I. Hadi, V. Hankel, L. Ertl, U. Ganswindt, C. Belka, and M. Niyazi state that there are no conflicts of interest.

Additional information

S. Corradini and I. Hadi contributed equally.

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Corradini, S., Hadi, I., Hankel, V. et al. Radiotherapy of spinal cord gliomas. Strahlenther Onkol 192, 139–145 (2016). https://doi.org/10.1007/s00066-015-0917-0

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