Elsevier

World Neurosurgery

Volume 106, October 2017, Pages 113-119
World Neurosurgery

Original Article
Primary Spinal Cord Glioblastoma Multiforme: A Retrospective Study of Patients at a Single Institution

https://doi.org/10.1016/j.wneu.2017.03.120Get rights and content

Background and Objective

Primary spinal cord (PSC) glioblastoma multiforme (GBM) is extremely rare and accounts for only 1.5% of all spinal cord tumors. Therefore, its treatment is still ill defined. To elucidate prognostic factors, we performed a single-institutional retrospective review of the largest series to date of patients with PSC GBM who underwent surgical resection in West China Hospital between 2008 and 2014. A total of 14 patients with PSC GBM were reviewed.

Methods

Demographic, operative, and postoperative factors were recorded. Overall survival (OS) and progression-free survival (PFS) were calculated and compared with the Kaplan-Meier method.

Results

Eight males (57%) and 6 females (43%) were involved in the study. Their median age was 28 years (range, 14–56 years). Median Karnofsky Performance Status score was 60 (range, 20–90). Four patients (28.6%) received gross total resection, 5 (35.7%) partial resection, and the remaining 5 (35.7%) biopsy only. Nine patients (64.3%) received postoperative radiotherapy and chemotherapy, 3 (21.4%) chemotherapy only, and 2 (14.3%) neither. Median follow-up period was 15 months (range, 5–26 months). One-year and 2-year survival was 78.5% (11/14) and 7.1% (1/14), respectively. Median OS was 15 months, and median PFS 8 months. Univariate log-rank analysis showed that OS and PFS were significantly associated with patients' age (P = 0.007 and P = 0.04, respectively) and postoperative radiotherapy (P = 0.001 and P = 0.002, respectively). However, preoperative Karnofsky Performance Status score affected only OS and did not affect PFS (P = 0.033 and P = 0.106, respectively).

Conclusions

According to our study, the combination of postoperative radiotherapy and temozolomide chemotherapy can improve prognosis and may serve as a feasible postoperative adjuvant treatment of PSC GBM.

Introduction

Among adults, glioblastoma multiforme (GBM) is the most common primary malignant tumor of central nervous system. Nevertheless, most GBMs occur in brain. Primary spinal cord (PSC) GBM is extremely rare, accounting for only 1.5% of all spinal cord tumors.1, 2 To the best of our knowledge, the literature on this topic published in the last 10 years is mainly restricted to single case reports or small case series. The report on the largest-scale PSC GBM case of adults to date is a single-center clinical retrospective study (involving 6 patients) with a long time span from 1990 to 2015.3 The prognosis of GBM is still poor despite progress in the treatment of gliomas. The overall survival (OS) of patients with PSC GBM is approximately 10–12 months. In contrast, its intracranial counterpart has a better prognosis of 15–22 months.4 PSC GBM would result in death as a result of its complications related to progressive involvement, respiratory impairment, and cerebral metastases.5 Only limited information about PSC GBM is available because of the lack of cases. To identify the natural history and clinical therapeutic factors that influence the prognosis of tumor, we performed a single-institutional study of the largest series of PSC GBM to date and reviewed previous reports.

Section snippets

Patient Selection

After obtaining approval from the ethics review board, we carried out a retrospective review of the patients of West China Hospital with primary intramedullary spinal cord tumors and pathologic diagnoses of GBM during the period between 2008 and 2014. Fourteen patients with PSC GBM were identified. All patients were evaluated with enhanced brain and spinal magnetic resonance imaging before the operation and given maximal safe resection during the operation. Demographic and clinical

Patient Characteristics

The clinical features of the 14 patients with PSC GBM are shown in Table 1. Eight males (57%) and 6 females (43%) were involved in the current study. Their median age was 28 years (range, 14–56 years). Median KPS score was 60 (range, 20–90). The tumors were located in cervical (n = 3, 21%), cervicothoracic (n = 1, 8%), thoracic (n = 4, 29%), thoracolumbar (n = 3, 21%), lumbar (n = 3, 21%), and non–conus medullaris/cauda equina region. The most frequent symptoms included neck, chest and waist

General Aspects

GBM is the most common primary malignant brain tumor in adults. However, their metastases to spinal cord or primary spinal locations are rare. Although our study is a single-institutional review of the largest series of PSC GBM to date, these 14 patients represent only less than 1% of all patients with intramedullary neoplasms treated in our institution. Different from brain GBM, treatment and prognosis of PSC GBM are still controversial because of the paucity of large case series.2, 4 We

Conclusions

The treatment outcome of PSC GBM remains poor, and its successful treatment is still a formidable and inevitable task. In accordance with the result of this single-center retrospective study, radiotherapy in combination with postoperative chemotherapy is the major prognostic factor for longer survival. However, the EOR does not have any relevance. Instead, GTR may worsen the deficits in some cases. For us, this is a preliminary retrospective study based on the analysis of limited samples and

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    Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

    Xing Cheng and Silong Lou contributed equally to this work and are co-first authors.

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