Advertisement

Journal of Neuro-Oncology

, Volume 47, Issue 3, pp 231–238 | Cite as

Radiation Therapy and the Management of Intramedullary Spinal Cord Tumors

  • Steven R. Isaacson
Article

Abstract

The use of radiation therapy in the management of intramedullary spinal cord tumors remains controversial. Several studies indicate that the use of postoperative radiation therapy modestly improves both local control and survival in spinal cord ependymomas and astrocytomas. Modern treatment planning and imaging allow more accurate target definition and respect for related normal tissue tolerances.

astrocytoma ependymoma spinal cord tumor radiation therapy 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    McCormick PC, Stein BM: Intramedullary tumors in adults. Neurosurg Clin N Am 1: 609-630, 1990Google Scholar
  2. 2.
    Coxe WS: Tumors of the spinal canal in children. Am J Surg 27: 62-73, 1961Google Scholar
  3. 3.
    Cooper PR, Epstein F: Radical resection of intramedullary spinal cord tumors in adults: recent experience in 29 patients. J Neurosurg 63: 492-499, 1985Google Scholar
  4. 4.
    DeSousa AL, Kalsbeck JE, Mealey Jr J, Campbell RL, Hockey A: Intraspinal tumors in children. A review of 81 cases. J Neurosurg 51: 437-445, 1979Google Scholar
  5. 5.
    Cristante L, Hermann HD: Surgical management of intramedullary spinal cord tumors: functional outcome and source morbidity. Neurosurgery 35: 69-76, 1994Google Scholar
  6. 6.
    Epstein F, Epstein N: Surgical treatment of spinal cord astrocytomas of childhood. A series of 19 patients. J Neurosurg 57: 685-689, 1982Google Scholar
  7. 7.
    Epstein F, Wisoff J: Intra-axial tumors of the cervicomedullary junction. J Neurosurg 67: 483-487, 1987Google Scholar
  8. 8.
    Epstein FJ, Farmer JP, Freed D: Adult intramedullary spinal cord ependymomas: the result of surgery in 38 patients. J Neurosurg 79: 204-209, 1993Google Scholar
  9. 9.
    Ferrante L, Mastronardi L, Celli P, Lunardi P, Acqui M, Fortuna A: Intramedullary spinal cord ependymomas-a study of 45 cases with long-term follow-up. Acta Neurochir (Wien) 119: 74-79, 1992Google Scholar
  10. 10.
    Halstead LS, Seager SW: The effects of rectal probe electrostimulation on spinal cord injury spasticity. Paraplegia 29: 43-47, 1991Google Scholar
  11. 11.
    Hardison HH, Packer RJ, Rorke LB, Schut L, Sutton LN, Bruce DA: Outcome of children with primary intramedullary spinal cord tumors. Childs Nerv Syst 3: 89-92, 1987Google Scholar
  12. 12.
    Malis LI: Intramedullary spinal cord tumors. Clin Neurosurg 25: 512-539, 1978Google Scholar
  13. 13.
    McCormick PC, Torres R, Post KD, Stein BM: Intramedullary ependymoma of the spinal cord. J Neurosurg 72: 523-532, 1990Google Scholar
  14. 14.
    O'Sullivan C, Jenkin RD, Doherty MA, Hoffman HJ, Greenberg ML: Spinal cord tumors in children: long-term results of combined surgical and radiation treatment. J Neurosurg 81: 507-512, 1994Google Scholar
  15. 15.
    Reimer R, Onofrio BM: Astrocytomas of the spinal cord in children and adolescents. J Neurosurg 63: 669-675, 1985Google Scholar
  16. 16.
    Rossitch Jr E, Zeidman SM, Burger PC, Curnes JT, Harsh C, Anscher M, Oakes WJ: Clinical and pathological analysis of spinal cord astrocytomas in children. Neurosurgery 27: 193-196, 1990Google Scholar
  17. 17.
    Sandler HM, Fapadopoulos SM, Thornton Jr AF, Ross DA: Spinal cord astrocytomas: results of therapy. Neurosurgery 30: 490-493, 1992Google Scholar
  18. 18.
    Waldron JN, Laperriere NJ, Jaakkimainen L, Simpson WJ, Payne D, Milosevic M, Wong CS: Spinal cord ependymomas: a retrospective analysis of 59 cases. Int J Radiat Oncol Biol Phys 27: 223-229, 1993Google Scholar
  19. 19.
    Whitaker SJ, Bessell EM, Ashley SE, Bloom HJ, Bell BA, Brada M: Postoperative radiotherapy in the management of spinal cord ependymoma. J Neurosurg 74: 720-728, 1991Google Scholar
  20. 20.
    Kopelson G, Linggood RM, Kleinman GM, Doucette J, Wang CC: Management of intramedullary spinal cord tumors. Radiology 135: 473-479, 1980Google Scholar
  21. 21.
    Linstadt DE, Wara WM, Leibel SA, Gutin PH, Wilson CB, Sheline GE: Postoperative radiotherapy of primary spinal cord tumors. Int J Radiat Oncol Biol Phys 16: 1397-1403, 1989Google Scholar
  22. 22.
    Shaw EG, Evans RG, Scheithauer BW, Ilstrup DM, Earle JD: Radiotherapeutic management of adult intraspinal ependymomas. Int J Radiat Oncol Biol Phys 12: 323-327, 1986Google Scholar
  23. 23.
    Kopelson G, Linggood RM: Intramedullary spinal cord astrocytoma versus glioblastoma: the prognostic importance of histologic grade. Cancer 50: 732-735, 1982Google Scholar
  24. 24.
    Cohen AR, Wisoff JH, Allen JC, Epstein F: Malignant astrocytomas of the spinal cord. J Neurosurg 70: 50-54, 1989Google Scholar
  25. 25.
    Boggan JE, Hoff JT, Wara WM, Boldrey EB: Intraspinal tumors in children. West J Med 133: 108-114, 1980Google Scholar
  26. 26.
    Cooper FR: Outcome after operative treatment of intramedullary spinal cord tumors in adults: intermediate and long-term results in 51 patients. Neurosurgery 25: 855-859, 1989Google Scholar
  27. 27.
    Stein BM: Surgery of intramedullary spinal cord tumors. Clin Neurosurg 26: 529-542, 1979Google Scholar
  28. 28.
    Larson DA: Radiation therapy of tumors of the spine. In: Youman JR (ed) Neurological Surgery. WB Saunders, Philadelphia, 1996, 3168 ppGoogle Scholar
  29. 29.
    Marks JE, Adler SJ: A comparative study of ependymomas by site of origin. Int J Radiat Oncol Biol Phys 8: 37-43, 1982Google Scholar
  30. 30.
    McLaughlin MP, Buatti JM, Marcus Jr RB, Maria BL, Mickle PJ, Kedar A: Outcome after radiotherapy of primary spinal cord glial tumors. Rad Oncol Invest 6:276-280, 1998Google Scholar
  31. 31.
    Shirato H, Kamada T, Hida K, Koyanagi I, Iwasaki Y, Miyasaka K, Abe H: The role of radiotherapy in the management of spinal cord glioma. Int J Radiat Oncol Biol Phys 33: 323-328, 1995Google Scholar
  32. 32.
    Rawlings CEI, Giangaspero F, Burger PC, Bullard DE: Ependymomas: a clinicopathologic study. Surg Neurol 29: 271-281, 1988Google Scholar
  33. 33.
    Sonneland PRL, Scheithauer BW, Onofrio BM: Myxopapillary ependymoma: a clinicopathologic and immunnocytochemical study of 77 cases. Cancer 56: 883-893, 1985Google Scholar
  34. 34.
    Wen BC, Hussey DH, Hitchon PW, Schelper RL, Vigliotti AP, Doornbos JF, VanGilder JC: The role of radiation therapy in the management of ependymomas of the spinal cord. Int J Radiat Oncol Biol Phys 20: 781-786, 1991Google Scholar
  35. 35.
    Guidetti B, Mercuri S, Vagnozzi R: Long-term results of the surgical treatment of 129 intramedullary spinal gliomas. J Neurosurg 1981: 323-330, 1981Google Scholar
  36. 36.
    Linstadt DE, Edwards MS, Prados M, Larson DA, Wara WM: Hyperfractionated irradiation for adults with brainstem gliomas. Int J Radiat Oncol Biol Phys 20: 757-760, 1991Google Scholar
  37. 37.
    Chun HC, Schmidt-Ullrich RK, Wolfson A, Tercilla OF, Sagerman RH, King GA: External beam radiotherapy for primary spinal cord tumors. J Neuro-Oncol 9: 211-217, 1990Google Scholar
  38. 38.
    Garcia DM: Primary spinal cord tumors treated with surgery and postoperative irradiation. Int J Radiat Oncol Biol Phys 11: 1933-1939, 1985Google Scholar
  39. 39.
    Garrett PG, Simpson WJK: Ependymomas: results of radiation treatment. Int J Radiat Oncol Biol Phys 9: 1121-1124, 1983Google Scholar
  40. 40.
    Peschel RE, Kapp DS, Cardinale F, Manuelidis EE: Ependymomas of the spinal cord. Int J Radiat Oncol Biol Phys 9: 1093-1096, 1983Google Scholar
  41. 41.
    Scott M: Infiltrating ependymomas of the cauda equina. Treatment by conservative surgery plus radiotherapy. J Neurosurg 41: 446-448, 1974Google Scholar
  42. 42.
    Hulshof MC, Menten J, Dito JJ, Dreissen JJ, van den Bergh R, Gonzalez Gonzalez D: Treatment results in primary intraspinal gliomas. Radiother Oncol 29: 294-300, 1993Google Scholar
  43. 43.
    Clover LL, Hazuka MB, Kinzie JJ: Spinal cord ependymomas treated with surgery and radiation therapy. A review of 11 cases. Am J Clin Oncol 16: 350-353, 1993Google Scholar
  44. 44.
    Ciappetta P, Salvati M, Capoccia G, Artico M, Raco A, Fortuna A: Spinal glioblastomas: report of seven cases and review of the literature. Neurosurgery 28: 302-306, 1991Google Scholar
  45. 45.
    Halperin EC: Concerning the inferior portion of the spinal radiotherapy field for malignancies that disseminate via the cerebrospinal fluid. Int J Radiat Oncol Biol Phys 26: 357-362, 1993Google Scholar
  46. 46.
    Schultheiss TE, Stephens LC, Jiang GL, Ang KK, Peters LJ: Radiation myelopathy in primates treated with conventional fractionation. Int J Radiat Oncol Biol Phys 19: 935-940, 1990Google Scholar
  47. 47.
    Wara WM, Phillips TL, Sheline GE, Schwade JG: Radiation tolerance of the spinal cord. Cancer 35: 1558-1562, 1975Google Scholar
  48. 48.
    Phillips TL, Buschke F: Radiation tolerance of the thoracic spinal cord. Am J Roentgenol Radium Ther Nud Med 105: 659-664, 1969Google Scholar
  49. 49.
    Cooper Jr RA, Phillips TL (eds) Radiation biology and radiation pathology syllabus. American College of Radiology, Chicago, 1975Google Scholar
  50. 50.
    Marcus Jr RB, Million RR: The incidence of myelitis after irradiation of the cervical spinal cord. Int J Radiat Oncol Biol Phys 19: 3-8, 1990Google Scholar
  51. 51.
    van der Kogel AJ: Retreatment tolerance of the spinal cord. Int J Radiat Oncol Biol Phys 26: 715-717, 1993Google Scholar
  52. 52.
    KimYH, Fayos JV: Radiation tolerance of the cervical spinal cord. Radiology 139: 473-478, 1981Google Scholar
  53. 53.
    Schultheiss TE, Kun LE, Ang KK, Stephens LC: Radiation response of the central nervous system. Int J Radiat Oncol Biol Phys 31: 1093-1112, 1995Google Scholar
  54. 54.
    Schultheiss TE, Stephens LC: The pathogenesis of radiation myelopathy: widening the circle. Int J Radiat Oncol Biol Phys 23: 1089-1091; discussion 1093-1084, 1992Google Scholar
  55. 55.
    van den Aarweg GJMJ, Hopewell JW, Whitehouse EM: The radiation response of the cervical spinal cord of the pig: effects of changing the irradiated volume. Int J Radiat Oncol Biol Phys 31: 51-55, 1995Google Scholar
  56. 56.
    Schultheiss TE, Stephens LC, Ang KK, Price RE, Peters LJ: Volume effects in rhesus monkey spinal cord. Int J Radiat Oncol Biol Phys 29: 67-72, 1994Google Scholar
  57. 57.
    Sundaresan N, Gutierrez FA, Larsen MB: Radiation myelopathy in children. Ann Neurol 4: 47-50, 1978Google Scholar
  58. 58.
    Ruifrok AC, Kleiboer BJ, van der Kogel AJ: Radiation tolerance and fractionation sensitivity of the developing rat cervical spinal cord. Int J Radiat Oncol Biol Phys 24: 505-510, 1992Google Scholar
  59. 59.
    Ang KK, Price RE, Stephens LC, Jiang GL, Feng Y, Schultheiss TE, Peters LJ: The tolerance of primate spinal cord to re-irradiation. Intl Radiat Oncol Biol Phys 25: 459-464, 1993Google Scholar
  60. 60.
    Allen JC, Helson L: High-dose cyclophosphamide chemotherapy for recurrent CNS tumors in children. J Neurosurg 55: 749-756, 1981Google Scholar
  61. 61.
    Clayton PE, Shalet SM: The evolution of spinal growth after irradiation. Clin Oncol (R Coll Radiol) 3: 220-222, 1991Google Scholar
  62. 62.
    Duffner PK, Horowitz ME, Krischer JP, Friedman HS, Burger PC, Cohen ME, Sanford RA, Mulhern RK, James HE, Freeman CR, Seidel FG, Kun LE: Postoperative chemotherapy and delayed radiation in children less than three years of age with malignant brain tumors. N Engl J Med 328: 1725-1731, 1993Google Scholar
  63. 63.
    Goldwein JW, Corn BW, Finlay JL, Packer RJ, Rorke LB, Schut L: Is craniospinal irradiation required to cure children with malignant (anaplastic) intracranial ependymomas? Cancer 67: 2766-2771, 1991Google Scholar
  64. 64.
    Dirks PB, Jay V, Becker LE, Drake JM, Humphreys RP, Hoffman HJ, Rutka JT: Development of anaplastic changes in low-grade astrocytomas of childhood. Neurosurgery 34: 68-78, 1994Google Scholar
  65. 65.
    Constantini S, Houten J, Miller DC, Freed D, Ozek MM, Rorke LB, Allen JC, Epstein FJ: Intramedullary spinal cord tumors in children under the age of 3 years. J Neurosurg 85: 1036-1043, 1996Google Scholar

Copyright information

© Kluwer Academic Publishers 2000

Authors and Affiliations

  • Steven R. Isaacson
    • 1
  1. 1.Department of RadiationCollege of Physicians and Surgeons of Columbia UniversityNew YorkUSA

Personalised recommendations