PDF(Pubmed)
Abstract：
Intramedullary astrocytomas (IMAs) are the second most frequent intramedullary tumors in adults. Low-grade IMAs (LG-IMA, WHO grade I and II) carry a better prognosis than high-grade IMAs (HG-IMAs). However, adjuvant treatment of LG-IMAs by radiotherapy (RT) and/or chemotherapy (CT) as well as treatment of tumor recurrences remains controversial. The aim of our study was to evaluate the postoperative outcome of LG-IMAs and the management of recurring tumors. We retrospectively reviewed a series of patients operated on for IMA from 1980 to 2022 in a single neurosurgical department. We retrieved 40 patients who received surgery for intramedullary astrocytomas, including 30 LG-IMAs (22 WHO grade I; 5 WHO grade II; 3 \"low-grade\") and 10 HG-IMAs (4 WHO grade III; 5 WHO grade IV; 1 \"high-grade\"). Of the patients with LG-IMAs, the extent of surgical resection was large (gross or subtotal resection >90%) in 30% of cases. Immediate postoperative radiotherapy and/or chemotherapy was proposed only to patients who underwent biopsy (n = 5), while others were initially followed-up. Over a median follow-up of 59 months (range = 13-376), 16 LG-IMA (53.3%) recurred with a mean delay of 28.5 months after surgery (range = 3-288). These included seven biopsies, five partial resections (PR), four subtotal resections (STR) but no gross total resections (GTR). Progression-free survival for LG-IMAs was 51.9% at 3 years and 35.6% at 5 and 10 years; overall survival was 96.3% at 3 years; 90.9% at 5 years and 81.9% at 10 years. There were no significant differences in terms of OS and PFS between WHO grade I and grade II tumors. However, \"large resections\" (GTR or STR), as opposed to \"limited resections\" (PR and biopsies), were associated with both better OS (p = 0.14) and PFS (p = 0.04). The treatment of recurrences consisted of surgery alone (n = 3), surgery with RT and/or CT (n = 2), RT with CT (n = 3), RT alone (n = 2) or CT alone (n = 2). In conclusion, although LG-IMAs are infiltrating tumors, the extent of resection (GTR or STR), but not WHO grading, is the main prognostic factor. The management of recurring tumors is highly variable with no conclusive evidence for either option.
摘要：
髓内星形细胞瘤（IMAs）是成人第二常见的髓内肿瘤。低等级IMA(LG-IMA，WHOI级和II级）比高级IMA（HG-IMA）具有更好的预后。然而,通过放疗（RT）和/或化疗（CT）对LG-IMAs的辅助治疗以及肿瘤复发的治疗仍存在争议。我们研究的目的是评估LG-IMAs的术后结局和复发性肿瘤的治疗。我们回顾性回顾了1980年至2022年在单个神经外科接受IMA手术的一系列患者。我们检索到40名接受髓内星形细胞瘤手术的患者，包括30个LG-IMA（22个WHO一级；5个WHO二级；3个“低等级”）和10个HG-IMA（4个WHO三级；5个WHO四级；1个“高级”）。在LG-IMAs患者中，在30%的病例中,手术切除范围较大(总切除或次全切除>90%).术后立即放疗和/或化疗仅被建议用于接受活检的患者（n=5），而其他人最初被跟进。中位随访59个月（范围=13-376），16LG-IMA（53.3%）术后复发，平均延迟28.5个月（范围=3-288）。其中包括七个活检，五次部分切除（PR），四次小计切除（STR），但没有总切除（GTR）。LG-IMAs的无进展生存率在3年为51.9%，在5年和10年为35.6%；总生存率在3年为96.3%；5年为90.9%，10年为81.9%。WHOI级和II级肿瘤之间的OS和PFS没有显着差异。然而,“大切除”（GTR或STR），与“有限切除”(PR和活检)相反，与更好的OS(p=0.14)和PFS(p=0.04)相关。复发的治疗包括单独手术（n=3），RT和/或CT手术（n=2），RT与CT（n=3），单独RT(n=2)或单独CT(n=2)。总之,尽管LG-IMAs是浸润性肿瘤，切除范围（GTR或STR），但不是世卫组织的评分，是主要的预后因素。复发肿瘤的管理是高度可变的，没有任何选择的确凿证据。
