Top

Child's Nervous System

Published in:

01-01-2021 | Glioma | Original Article

Pediatric primary high-grade spinal glioma: a National Cancer Database analysis of current patterns in treatment and outcomes

Authors: Ravi S. Nunna, Syed Khalid, Mandana Behbahani, Ankit I. Mehta

Published in: Child's Nervous System | Issue 1/2021

Abstract

Purpose

Pediatric primary high-grade spinal glioma (p-HGSG) is an extremely rare disease process, with little data within the current literature. Akin to primary high-grade gliomas, this cancer has been exemplified by dismal prognosis and poor response to modern treatment paradigms. This study seeks to investigate the current trends affecting overall survival using the National Cancer Database (NCDB).

Methods

The NCDB was queried for p-HGSG between 2004 and 2016, by utilizing the designated diagnosis codes. Kaplan-Meier curves were generated, and log-rank testing was performed to analyze factors affecting overall survival. In addition, a Cox proportional-hazards model was used to perform multivariate regression analysis of survival outcomes.

Results

A cohort of 97 patients was identified with a histologically confirmed p-HGSG. The overall incidence of p-HGSG in all pediatric spinal cord tumors is 7.5%, with a mean survival time of 25.3 months (SD, 21.0) and 5-year overall survival of 17.0%. The majority of patients underwent surgery (n = 87, 89.7%), radiotherapy (n = 73, 75.3%), and chemotherapy (n = 60, 61.9%). Univariate, multivariate, and Kaplan-Meier log-rank testing failed to demonstrate an association between performing surgery, extent of resection, radiotherapy, or chemotherapy with improved survival outcomes.

Conclusions

The current study constitutes the largest retrospective analysis of p-HGSGs to date, finding that current treatment options of surgery, radiotherapy, and chemotherapy have unclear benefit. This disease process has a poor prognosis without a current modality of treatment that conclusively alters survival. The risks and side effects of these treatment modalities must be carefully considered in such a highly aggressive disease process, especially given potentially limited survival benefits.

Ostrom QT, Cioffi G, Gittleman H, Patil N, Waite K, Kruchko C, Barnholtz-Sloan JS (2019) CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2012-2016. Neuro-Oncol 21:v1–v100. https://doi.org/10.1093/neuonc/noz150CrossRefPubMedPubMedCentral

DeSousa AL, Kalsbeck JE, Mealey J et al (1979) Intraspinal tumors in children. A review of 81 cases. J Neurosurg 51:437–445. https://doi.org/10.3171/jns.1979.51.4.0437CrossRefPubMed

Constantini S, Houten J, Miller DC, Freed D, Ozek MM, Rorke LB, Allen JC, Epstein FJ (1996) Intramedullary spinal cord tumors in children under the age of 3 years. J Neurosurg 85:1036–1043. https://doi.org/10.3171/jns.1996.85.6.1036CrossRefPubMed

Reimer R, Onofrio BM (1985) Astrocytomas of the spinal cord in children and adolescents. J Neurosurg 63:669–675. https://doi.org/10.3171/jns.1985.63.5.0669CrossRefPubMed

Lam S, Lin Y, Melkonian S (2012) Analysis of risk factors and survival in pediatric high-grade spinal cord astrocytoma: a population-based study. Pediatr Neurosurg 48:299–305. https://doi.org/10.1159/000353135CrossRefPubMed

Benesch M, Frappaz D, Massimino M (2012) Spinal cord ependymomas in children and adolescents. Childs Nerv Syst ChNS Off J Int Soc Pediatr Neurosurg 28:2017–2028. https://doi.org/10.1007/s00381-012-1908-4CrossRef

Kutluk T, Varan A, Kafalı C, Hayran M, Söylemezoğlu F, Zorlu F, Aydın B, Yalçın B, Akyüz C, Büyükpamukçu M (2015) Pediatric intramedullary spinal cord tumors: a single center experience. Eur J Paediatr Neurol EJPN Off J Eur Paediatr Neurol Soc 19:41–47. https://doi.org/10.1016/j.ejpn.2014.09.007CrossRef

Rossitch E, Zeidman SM, Burger PC et al (1990) Clinical and pathological analysis of spinal cord astrocytomas in children. Neurosurgery 27:193–196. https://doi.org/10.1097/00006123-199008000-00003CrossRefPubMed

Alvi MA, Ida CM, Paolini MA, Kerezoudis P, Meyer J, Barr Fritcher EG, Goncalves S, Meyer FB, Bydon M, Raghunathan A (2019) Spinal cord high-grade infiltrating gliomas in adults: clinico-pathological and molecular evaluation. Mod Pathol Off J U S Can Acad Pathol Inc 32:1236–1243. https://doi.org/10.1038/s41379-019-0271-3CrossRef

10.

Wolff B, Ng A, Roth D, Parthey K, Warmuth-Metz M, Eyrich M, Kordes U, Kortmann R, Pietsch T, Kramm C, Wolff JEA (2012) Pediatric high grade glioma of the spinal cord: results of the HIT-GBM database. J Neuro-Oncol 107:139–146. https://doi.org/10.1007/s11060-011-0718-yCrossRef

11.

Konar SK, Bir SC, Maiti TK, Nanda A (2017) A systematic review of overall survival in pediatric primary glioblastoma multiforme of the spinal cord. J Neurosurg Pediatr 19:239–248. https://doi.org/10.3171/2016.8.PEDS1631CrossRefPubMed

12.

Allen JC, Aviner S, Yates AJ, Boyett JM, Cherlow JM, Turski PA, Epstein F, Finlay JL, _ _ (1998) Treatment of high-grade spinal cord astrocytoma of childhood with “8-in-1” chemotherapy and radiotherapy: a pilot study of CCG-945. Children’s Cancer Group. J Neurosurg 88:215–220. https://doi.org/10.3171/jns.1998.88.2.0215CrossRefPubMed

13.

Tendulkar RD, Pai Panandiker AS, Wu S, Kun LE, Broniscer A, Sanford RA, Merchant TE (2010) Irradiation of pediatric high-grade spinal cord tumors. Int J Radiat Oncol Biol Phys 78:1451–1456. https://doi.org/10.1016/j.ijrobp.2009.09.071CrossRefPubMedPubMedCentral

14.

Guss ZD, Moningi S, Jallo GI, Cohen KJ, Wharam MD, Terezakis SA (2013) Management of pediatric spinal cord astrocytomas: outcomes with adjuvant radiation. Int J Radiat Oncol Biol Phys 85:1307–1311. https://doi.org/10.1016/j.ijrobp.2012.11.022CrossRefPubMedPubMedCentral

15.

Indelicato DJ, Rotondo RL, Uezono H, Sandler ES, Aldana PR, Ranalli NJ, Beier AD, Morris CG, Bradley JA (2019) Outcomes following proton therapy for pediatric low-grade Glioma. Int J Radiat Oncol Biol Phys 104:149–156. https://doi.org/10.1016/j.ijrobp.2019.01.078CrossRefPubMed

16.

Constantini S, Miller DC, Allen JC, Rorke LB, Freed D, Epstein FJ (2000) Radical excision of intramedullary spinal cord tumors: surgical morbidity and long-term follow-up evaluation in 164 children and young adults. J Neurosurg 93:183–193. https://doi.org/10.3171/spi.2000.93.2.0183CrossRefPubMed

17.

Kheirkhah P, Denyer S, Bhimani AD, Arnone GD, Esfahani DR, Aguilar T, Zakrzewski J, Venugopal I, Habib N, Gallia GL, Linninger A, Charbel FT, Mehta AI (2018) Magnetic drug targeting: a novel treatment for intramedullary spinal cord tumors. Sci Rep 8:11417. https://doi.org/10.1038/s41598-018-29736-5CrossRefPubMedPubMedCentral

18.

Wang SS, Bandopadhayay P, Jenkins MR (2019) Towards immunotherapy for pediatric brain tumors. Trends Immunol 40:748–761. https://doi.org/10.1016/j.it.2019.05.009CrossRefPubMed

19.

Rajesh Y, Pal I, Banik P, Chakraborty S, Borkar SA, Dey G, Mukherjee A, Mandal M (2017) Insights into molecular therapy of glioma: current challenges and next generation blueprint. Acta Pharmacol Sin 38:591–613. https://doi.org/10.1038/aps.2016.167CrossRefPubMedPubMedCentral

20.

Alinezhad A, Jafari F (2019) Novel management of glioma by molecular therapies, a review article. Eur J Transl Myol 29. https://doi.org/10.4081/ejtm.2019.8209

Title: Pediatric primary high-grade spinal glioma: a National Cancer Database analysis of current patterns in treatment and outcomes
Authors: Ravi S. Nunna
Syed Khalid
Mandana Behbahani
Ankit I. Mehta
Publication date: 01-01-2021
Publisher: Springer Berlin Heidelberg
Keywords: Glioma
Glioma
Radiotherapy
Glioma
Cytostatic Therapy
Published in: Child's Nervous System / Issue 1/2021
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-020-04722-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Pediatric primary high-grade spinal glioma: a National Cancer Database analysis of current patterns in treatment and outcomes

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Fusiform dilatation of internal carotid artery after pterional but not subfrontal craniotomy in 6 patients

Caregivers’ evaluation of an educational material targeted to children with hydrocephalus

Baclofen pump with pre-brainstem catheter tip placement: technical note and case series

Comparison of anticoagulation and antiplatelet therapy for treatment of blunt cerebrovascular injury in children <10 years of age: a multicenter retrospective cohort study

Diagnosis and management of cerebral venous sinus thrombosis in children: a single-center retrospective analysis

Nerve transfers for acute flaccid myelitis: a case series