paediatrics Brussels 17

J Neurooncol (2006)

Treatment results

from any cause, progression-free survival (PFS) the time from diagnosis to a first recurrence of disease (i.e., local or distant metastasis), and local tumor control (LC) the time from diagnosis to first local failure.

Surgery was the initial treatment in all patients. GTR was achieved in 21 patients (60%), STR in 13 (37%), and a biopsy only in 1 patient (3%). A total of 13 patients were observed after their surgery. These pa- tients included 11 patients who underwent GTR and 2 who underwent STR. RT was given adjuvantly after surgery to 22 patients (63%) and as salvage treatment of recurrent disease to 7 (20%). The median time to the start of adjuvant RT from the date of surgery was 47 days (range, 21–140 days). The total RT dose ranged from 44.3 to 56 Gy (median, 50.4 Gy), and the dose per fraction ranged from 1.5 Gy to 2 Gy (median, 1.8 Gy). In 13 patients, a cone-down field was used for the last med- ian 9 Gy (range, 3.6–13.5 Gy). A total of five patients underwent craniospinal irradiation (CSI) prescribed to a median dose of 39.6 Gy (range, 39.6–41 Gy) plus a median 10.8 Gy (range, 9–13.5 Gy) boost to the tumor bed for lepto- meningeal disease (LMD). One of the patients received CSI at the time of diagnosis of LMD. The remaining four patients had initially received local RT to the spine at diagnosis and subsequently were retreated with CSI due to recurrence of LMD. The median follow-up time was 10.7 years (range, 3–33 years). The OS rate at both 5 and 10 years was 97% (Fig. 1). Three patients died during the follow-up period. One died of MPE and the others of unknown causes 15 years after the initial diagnosis. There were 12 (34%) recurrences in the study population. The median time to disease recurrence was 65 months (range, 5–378 months). The 5- and 10-year PFS rates were 70% and 62%, respectively (Fig. 2), and 5- and 10-year LC rates were 76% and 72%, respectively. The influence on survival of both clinical and treatment variables was also examined. The prognostic variables we studied included age, Karnofsky perfor- mance status, duration of symptoms prior to diagnosis, tumor location, extent of surgery, initial treatment modality, and total RT dose. There were no statisti- cally significant associations between the prognostic variables and OS rate. However, older patient age ( £ 35 years vs. >35 years) ( P = 0.002) and initial treat- ment modality (surgery vs. surgery + adjuvant RT) significantly affected PFS (Fig. 3; P = 0.04) for the entire study group. The 5- and 10-year PFS rates for all patients who received adjuvant RT were 82% and Survival and local control

Results

Patient characteristics

Patient characteristics are summarized in Table 1. Of the 35 patients, 25 were males. The median age at diagnosis was 35 years. The most common presenting symptom was low back pain (94%). The median duration of symptoms before diagnosis was 12 months. The median KPS was 80. The most common initial imaging modality was MRI in 29 patients (83%). In 21 patients (60%) tumor location was lumbosacral/cauda equina region.

Table 1 Patient characteristics and treatment details

Number a

Variable

Number of patients

35

Age, years Median

35

Range

14–63

KPS b

Median Range

80

50–100

Gender

Female/Male

10/25

Symptoms

Low back pain

33 (94%) 15 (43%) 6 (17%) 5 (14%)

Extremity numbness Extremity weakness Urinary dysfunction

Abnormal gait

3 (9%)

Symptom duration, months Median

12

Range

1–84

Imaging modality Myelography

5 (14%) 1 (3%) 29 (83%)

CT

MRI

Tumor location

Thoracolumbar

14 (40%) 21 (60%)

Lumbosacral/cauda equina

Extent of surgery

Gross total resection Subtotal resection

21 (60%) 13 (37%)

Biopsy only

1 (3%)

Primary treatment Surgery

13 (37%) 22 (63%)

Surgery + RT

a Data are presented as number of patients unless otherwise indicated b KPS, Karnofsky performance status

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