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Treatment outcomes of radiotherapy for primary spinal cord glioma

 Seo Hee Choi  ;  Hong In Yoon  ;  Seong Yi  ;  Jong Won Park  ;  JaeHo Cho  ;  Dong Ah Shin  ;  Yoon Ha  ;  Dong-Seok Kim  ;  Se Hoon Kim  ;  Seung-Koo Lee  ;  Jong Hee Chang  ;  Chang-Ok Suh 
 Strahlentherapie und Onkologie, Vol.195(2) : 164-174, 2019 
Journal Title
 Strahlentherapie und Onkologie 
Issue Date
Craniospinal irradiation ; Glioma ; High-grade glioma ; Meningeal carcinomatosis ; Radiotherapy ; Spinal cord
PURPOSE: Spinal cord gliomas are rare, and there is no consensus on the optimal radiotherapy (RT) regimen. Herein, we investigated therapeutic outcomes in spinal cord gliomas to obtain clues for the optimal RT regimen. METHODS: We assessed 45 patients who received RT for primary spinal cord non-ependymoma gliomas between 2005 and 2017: 37 (82%) received postoperative RT, 6 (13%) underwent definitive RT without surgery, and 2 (5%) received salvage RT for recurrent tumors. Craniospinal irradiation (CSI; median, 40 Gy) was administered in 4 patients with seeding at diagnosis; all other patients received local RT only (median, 50.4 Gy). RESULTS: In all 23 failures occurred (20 in patients without initial seeding +3 in patients with initial seeding and CSI; median follow-up, 33 months). The 2‑year overall survival and progression-free survival rates were 74 and 54%, respectively. Overall, 13 (32%) new seeding events outside the local RT field developed either first or subsequently. Tumor grade was significantly associated with survival endpoints (p = 0.009, 0.028) and overall seeding rates (p = 0.042). In grade II tumors, seeding developed in 23%, with a dismal prognosis (median, 10 months after RT). In grade III tumors, seeding developed in 45% with diverse prognosis. In grade IV tumors, seeding developed in 45%. The survival of patients with newly developed seeding was significantly worse than the others (2-year 50%, p < 0.001). CONCLUSION: To encompass a considerable rate of progressive disease seeding, aggressive treatment such as pre-emptive application of CSI needs to be considered for high-grade spinal cord gliomas with adverse features. Prophylactic CSI could be an option for survival prolongation and requires prospective validation.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
김동석(Kim, Dong Seok)
김세훈(Kim, Se Hoon) ORCID logo https://orcid.org/0000-0001-7516-7372
서창옥(Suh, Chang Ok)
신동아(Shin, Dong Ah) ORCID logo https://orcid.org/0000-0002-5225-4083
윤홍인(Yoon, Hong In) ORCID logo https://orcid.org/0000-0002-2106-6856
이성(Yi, Seong)
이승구(Lee, Seung Koo) ORCID logo https://orcid.org/0000-0001-5646-4072
장종희(Chang, Jong Hee)
조재호(Cho, Jae Ho) ORCID logo https://orcid.org/0000-0001-9966-5157
최서희(Choi, Seo Hee) ORCID logo https://orcid.org/0000-0002-4083-6414
하윤(Ha, Yoon)
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