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

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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.

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References

  1. 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/noz150

    Article  PubMed  PubMed Central  Google Scholar 

  2. 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.1979.51.4.0437

    Article  CAS  PubMed  Google Scholar 

  3. 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.1996.85.6.1036

    Article  CAS  PubMed  Google Scholar 

  4. 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.1985.63.5.0669

    Article  CAS  PubMed  Google Scholar 

  5. 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/10.1159/000353135

    Article  PubMed  Google Scholar 

  6. 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/s00381-012-1908-4

    Article  Google Scholar 

  7. 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.2014.09.007

    Article  Google Scholar 

  8. 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/10.1097/00006123-199008000-00003

    Article  PubMed  Google Scholar 

  9. 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/s41379-019-0271-3

    Article  CAS  Google Scholar 

  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-y

    Article  Google Scholar 

  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.PEDS1631

    Article  PubMed  Google Scholar 

  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.1998.88.2.0215

    Article  CAS  PubMed  Google Scholar 

  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.2009.09.071

    Article  PubMed  PubMed Central  Google Scholar 

  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.2012.11.022

    Article  PubMed  PubMed Central  Google Scholar 

  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.2019.01.078

    Article  PubMed  Google Scholar 

  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.2000.93.2.0183

    Article  CAS  PubMed  Google Scholar 

  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/s41598-018-29736-5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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.2019.05.009

    Article  CAS  PubMed  Google Scholar 

  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.2016.167

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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

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Funding

The grant support from the AOSPine Innovation Grant (awarded to senior author) was utilized for funding this project.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Illinois at Chicago, 912 S. Wood Street, 451-N, Chicago, IL, 60612, USA

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

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  1. Ravi S. Nunna
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  2. Syed Khalid
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Correspondence to Ankit I. Mehta.

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Nunna, R.S., Khalid, S., Behbahani, M. et al. Pediatric primary high-grade spinal glioma: a National Cancer Database analysis of current patterns in treatment and outcomes. Childs Nerv Syst 37, 185–193 (2021). https://doi.org/10.1007/s00381-020-04722-3

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  • DOI: https://doi.org/10.1007/s00381-020-04722-3

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