Astrocytic Tumors of the Spinal Cord

  • Tania KaprealianEmail author


Primary spinal cord tumors are rare and account for 2–4% of all adult central nervous system tumors. Astrocytomas comprise approximately 6–8% of all spinal cord tumors. Tumor histology and grade are the most significant prognostic factors of primary spinal cord astrocytomas affecting overall survival.

MRI is the primary imaging modality used to diagnose intramedullary spinal tumors.

Achieving a good resection can be very difficult in spinal astrocytomas due to the involvement of the spinal cord itself. However, maximal safe surgical resection or biopsy is beneficial in diagnosing the patient and potentially providing symptom relief and improved outcomes.

Adjuvant radiation therapy is a useful yet controversial treatment modality in the treatment of spinal astrocytomas given the low rates of gross total resection. It is generally accepted to treat high-grade spinal astrocytomas with postoperative radiation therapy as well as in cases of subtotally resected grade II spinal astrocytomas. Whereas, resected spinal pilocytic astrocytomas and gross totally resected grade II spinal astrocytomas may be observed. The role and benefit of chemotherapy require additional studies; however, extracting from intracranial data, temozolomide and bevacizumab are commonly used, particularly in high-grade tumors.


Spinal cord low-grade astrocytoma High-grade astrocytoma Pilocytic Glioblastoma Central nervous system 







Anaplastic astrocytoma






Central nervous system


Cerebrospinal fluid


Computerized tomography


Clinical target volume






Gross tumor volume


High-grade astrocytoma


Intensity-modulated radiation therapy


Low-grade astrocytoma


Median survival




Not reported


Overall survival


Procarbazine, lomustine, and vincristine


Progression-free survival


Planning target volume


Recurrence-free survival


Radiation therapy


Radiation Therapy Oncology Group


Tolerance dose


Vascular endothelial growth factor


World Health Organization


  1. 1.
    Chamberlain MC, Tredway TL. Adult primary intradural spinal cord tumors: a review. Curr Neurol Neurosci Rep. 2011;11(3):320–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Minehan KJ, Shaw EG, Scheithauer BW, et al. Spinal cord astrocytoma: pathological and treatment considerations. J Neurosurg. 1995;83(4):590–5.PubMedCrossRefGoogle Scholar
  3. 3.
    Parsa AT, Chi JH, Acosta FL Jr, et al. Intramedullary spinal cord tumors: molecular insights and surgical innovation. Clin Neurosurg. 2005;52:76–84.PubMedGoogle Scholar
  4. 4.
    Raco A, Esposito V, Lenzi J, et al. Long-term follow-up of intramedullary spinal cord tumors: a series of 202 cases. Neurosurgery. 2005;56(5):972–81.PubMedGoogle Scholar
  5. 5.
    Hsu S, Quattrone M, Ostrom Q, et al. Incidence patterns for primary malignant spinal cord gliomas: a Surveillance, Epidemiology and End Results (SEER) study. J Neurosurg Spine. 2011;14(6):742–7.PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Huang B, Starostik P, Kühl J, et al. Loss of heterozygosity on chromosome 22 in human ependymomas. Acta Neuropathol. 2002;103(4):415–20.PubMedCrossRefGoogle Scholar
  7. 7.
    Zadnik PL, Gokaslan ZL, Burger PC, et al. Spinal cord tumours: advances in genetics and their implications for treatment. Nat Rev Neurol. 2013;9(5):257–66.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Manzano G, Green BA, Vanni S, et al. Contemporary management of adult intramedullary spinal tumors—pathology and neurological outcomes related to surgery. Spinal Cord. 2008;46(8):540–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Abul-Kasim K, Thurnher MM, McKeever, et al. Intradural spinal tumors: current classification and MRI features. Neuroradiology. 2008;50(4):301–14.PubMedCrossRefGoogle Scholar
  10. 10.
    Koeller KK, Rosenblum RS, Morrison AL. Neoplasms of the spinal cord and filum terminale: radiologic-pathologic correlation. Radiographics. 2000;20(6):1721–49.PubMedCrossRefGoogle Scholar
  11. 11.
    Timpone VM, Patel SH. MRI of a syrinx: is contrast material always necessary? Am J Roentgenol. 2015;204(5):1082–5.CrossRefGoogle Scholar
  12. 12.
    Louis DN, Perry A, Reifenberger G, et al. The 2016 World Health Organization classification of tumors of the central nervous system: a summary. Acta Neuropathol. 2016;131(6):803–20.PubMedCrossRefGoogle Scholar
  13. 13.
    Seki T, Hida K, Yano S, et al. Clinical factors for prognosis and treatment guidance of spinal cord astrocytoma. Asian Spine J. 2016;10(4):748–54.PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Wong AP, Dahdaleh NS, Fessler RG, et al. Risk factors and long-term survival in adult patients with primary malignant spinal cord astrocytomas. J Neurooncol. 2013;115(3):493–503.PubMedCrossRefGoogle Scholar
  15. 15.
    Innocenzi G, Salvati M, Cervoni L, et al. Prognostic factors in intramedullary astrocytomas. Clin Neurol Neurosurg. 1997;99(1):1–5.PubMedCrossRefGoogle Scholar
  16. 16.
    Milano MT, Johnson MD, Sul J, et al. Primary spinal cord glioma: a surveillance, epidemiology, and end results database study. J Neurooncol. 2010;98(1):83–92.PubMedCrossRefGoogle Scholar
  17. 17.
    Adams H, Avendano J, Raza SM, et al. Prognostic factors and survival in primary malignant astrocytomas of the spinal cord: a population-based analysis from 1973 to 2007. Spine. 2012;37(12):1–20.CrossRefGoogle Scholar
  18. 18.
    Sandler HM, Papadopoulos SM, Thornton AF Jr, et al. Spinal cord astrocytomas: results of therapy. Neurosurgery. 1992;30(4):490–3.PubMedGoogle Scholar
  19. 19.
    Rodrigues GB, Waldron JN, Wong CS, et al. A retrospective analysis of 52 cases of spinal cord glioma managed with radiation therapy. Int J Radiat Oncol Biol Phys. 2000;48(3):837–42.PubMedCrossRefGoogle Scholar
  20. 20.
    Santi M, Mena H, Wong K, et al. Spinal cord malignant astrocytomas. Clinicopathologic features in 36 cases. Cancer. 2003;98(3):554–61.PubMedCrossRefGoogle Scholar
  21. 21.
    Abdel-Wahab M, Etuk B, Palermo J, et al. Spinal cord gliomas: a multi-institutional retrospective analysis. Int J Radiat Oncol Biol Phys. 2006;64(4):1060–71.PubMedCrossRefGoogle Scholar
  22. 22.
    Minehan KJ, Brown PD, Scheithauer BW, et al. Prognosis and treatment of spinal cord astrocytoma. Int J Radiat Oncol Biol Phys. 2009;73(3):727–33.PubMedCrossRefGoogle Scholar
  23. 23.
    Constantini S, Miller DC, Allen JC, et al. Radical excision of intramedullary spinal cord tumors: surgical morbidity and long-term follow-up evaluation in 164 children and young adults. J Neurosurg. 2000;93(2 Suppl):183–93.PubMedGoogle Scholar
  24. 24.
    McGirt MJ, Goldstein IM, Chaichana KL, et al. Extent of surgical resection of malignant astrocytomas of the spinal cord: outcome analysis of 35 patients. Neurosurgery. 2008;63(1):55–60.PubMedCrossRefGoogle Scholar
  25. 25.
    Babu R, Karikari IO, Owens TR, et al. Spinal cord astrocytomas: a modern 20-year experience at a single institution. Spine. 2014;39(7):533–40.PubMedCrossRefGoogle Scholar
  26. 26.
    Garcés-Ambrossi GL, McGirt MJ, Mehta VA, et al. Factors associated with progression-free survival and long-term neurological outcome after resection of intramedullary spinal cord tumors: analysis of 101 consecutive cases. J Neurosurg Spine. 2009;11(5):591–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Babu R, Karikari IO, Owens TR, et al. Spinal cord astrocytomas. Spine. 2014;39(7):533–40.PubMedCrossRefGoogle Scholar
  28. 28.
    Karikari IO, Nimjee SM, Hodges TR, et al. Impact of tumor histology on resectability and neurological outcome in primary intramedullary spinal cord tumors: a single-center experience with 102 patients. Neurosurgery. 2015;68(1):188–97.CrossRefGoogle Scholar
  29. 29.
    Epstein FJ, Farmer J, Freed D. Adult intramedullary astrocytomas of the spinal cord. J Neurosurg. 1992;77(3):355–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Juthani RG, Bilsky MH, Vogelbaum MA. Current management and treatment modalities for intramedullary spinal cord tumors. Curr Treat Options Oncol. 2015;16(8):39.PubMedCrossRefGoogle Scholar
  31. 31.
    Klekamp J. Treatment of intramedullary tumors: analysis of surgical morbidity and long-term results. J Neurosurg Spine. 2013;19(1):12–26.PubMedCrossRefGoogle Scholar
  32. 32.
    Boström A, Kanther N-C, Grote A, et al. Management and outcome in adult intramedullary spinal cord tumours: a 20-year single institution experience. BMC Res Notes. 2014;7:908.PubMedPubMedCentralCrossRefGoogle Scholar
  33. 33.
    Huddart R, Traish D, Ashley S, et al. Management of spinal astrocytoma with conservative surgery and radiotherapy. Br J Neurosurg. 1993;7(5):473–81.PubMedCrossRefGoogle Scholar
  34. 34.
    Shirato H, Kamada T, Hida K, et al. The role of radiotherapy in the management of spinal cord glioma. Int J Radiat Oncol Biol Phys. 1995;33(2):323–8.PubMedCrossRefGoogle Scholar
  35. 35.
    Jyothirmaryi R, Madhavan J, Nair MK, et al. Conservative surgery and radiotherapy in the treatment of spinal cord astrocytoma. J Neurooncol. 1997;33(3):205–11.CrossRefGoogle Scholar
  36. 36.
    Robinson CG, Prayson RA, Hahn JF, et al. Long-term survival and functional status of patients with low-grade astrocytoma of spinal cord. Int J Radiat Oncol Biol Phys. 2005;63(1):91–100.PubMedCrossRefGoogle Scholar
  37. 37.
    Kahn J, Loeffler JS, Niemierko A, et al. Long-term outcomes of patients with spinal cord gliomas treated by modern conformal radiation techniques. Int J Radiat Oncol Biol Phys. 2011;81(1):232–8.PubMedCrossRefGoogle Scholar
  38. 38.
    Garcia D. Primary spinal cord tumors treated with surgery and postoperative irradiation. Int J Radiat Oncol Biol Phys. 1985;11(11):1933–9.PubMedCrossRefGoogle Scholar
  39. 39.
    Linstadt D, Wara WW, Leibel SA, et al. Postoperative radiotherapy of primary spinal cord tumors. Int J Radiat Oncol Biol Phys. 1989;16(6):1397–403.PubMedCrossRefGoogle Scholar
  40. 40.
    Nowak-Sadzikowska J, Gliński B. The value of postoperative radiotherapy of primary spinal cord glioma. Rep Pract Oncol Radiother. 2002;7(4):139–47.CrossRefGoogle Scholar
  41. 41.
    Cohen AR, Wisof JH, Allen JC, et al. Malignant astrocytomas of the spinal cord. J Neurosurg. 1989;70(1):50–4.PubMedCrossRefGoogle Scholar
  42. 42.
    Kim MS, Chung CK, Choe G, et al. Intramedullary spinal cord astrocytoma in adult: postoperative outcome. J Neurooncol. 2001;52(1):85–94.PubMedCrossRefGoogle Scholar
  43. 43.
    Isaacson SR. Radiation therapy and the management of intramedullary spinal cord tumors. J Neurooncol. 2000;47(3):231–8.PubMedCrossRefGoogle Scholar
  44. 44.
    Wara WM, Phillips TL, Sheline GE, et al. Radiation tolerance of the spinal cord. Cancer. 1975;35(6):1558–62.PubMedCrossRefGoogle Scholar
  45. 45.
    Phillips TL, Buschke F. Radiation tolerance of the thoracic spinal cord. Am J Roentgenol Radium Ther Nucl Med. 1969;105(3):659–64.PubMedCrossRefGoogle Scholar
  46. 46.
    Schultheiss TE, Stephens LC. The pathogenesis of radiation myelopathy: widening the circle. Int J Radiat Oncol Biol Phys. 1995;23(5):1089–93.CrossRefGoogle Scholar
  47. 47.
    Schultheiss TE, Kun LE, Ang KK, et al. Radiation response of the central nervous system. Int J Radiat Oncol Biol Phys. 1995;31(5):1093–112.PubMedCrossRefGoogle Scholar
  48. 48.
    Schultheiss TE. The radiation dose-response of the human spinal cord. Int J Radiat Oncol Biol Phys. 2008;71(5):145–1459.CrossRefGoogle Scholar
  49. 49.
    Kirkpatrick JP, van der Kogel AJ, Schultheiss TE. Radiation dose-volume effects in the spinal cord. Int J Radiat Oncol Biol Phys. 2010;76(3 Suppl):S42–9.PubMedCrossRefGoogle Scholar
  50. 50.
    Marcus RB Jr, Million RR. The incidence of myelitis after irradiation of the cervical spinal cord. Int J Radiat Oncol Biol Phys. 1990;19(1):3–8.PubMedCrossRefGoogle Scholar
  51. 51.
    Rampling R, Symonds P. Radiation myelopathy. Curr Opin Neurol. 1998;11(6):627–32.PubMedCrossRefGoogle Scholar
  52. 52.
    Schultheiss TE, Stephens LC, Ang KK, et al. Volume effects in rhesus monkey spinal cord. Int J Radiat Oncol Biol Phys. 1994;29(1):67–72.PubMedCrossRefGoogle Scholar
  53. 53.
    Schultheiss TE, Stephens LC, Jiang GL, et al. Radiation myelopathy in primates treated with conventional fractionation. Int J Radiat Oncol Biol Phys. 1990;19(4):935–40.PubMedCrossRefGoogle Scholar
  54. 54.
    Marks LB, Yorke ED, Jackson A, et al. Use of normal tissue complication probability models in the clinic. Int J Radiat Oncol Biol Phys. 2010;76(3 Suppl):S10–9.PubMedPubMedCentralCrossRefGoogle Scholar
  55. 55.
    Stupp R, Mason WP, van den Bent MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352(10):987–96.CrossRefPubMedGoogle Scholar
  56. 56.
    Kim WH, Yoon SH, Kim CY, et al. Temozolomide for malignant primary spinal cord glioma: an experience of six cases and a literature review. J Neurooncol. 2011;101(2):247–54.PubMedCrossRefGoogle Scholar
  57. 57.
    Chamberlain MC. Temozolomide for recurrent low-grade spinal cord gliomas in adults. Cancer. 2008;113(5):1019–24.PubMedCrossRefGoogle Scholar
  58. 58.
    Hernández-Durán S, Bergy A, Shah AH, et al. Primary spinal cord glioblastoma multiforme treated with temozolomide. J Clin Neurosci. 2015;22(12):1877–82.PubMedCrossRefGoogle Scholar
  59. 59.
    Chamberlain MC, Johnston SK. Recurrent spinal cord glioblastoma: salvage therapy with bevacizumab. J Neurooncol. 2011;102(3):427–32.PubMedCrossRefGoogle Scholar
  60. 60.
    Kaley TJ, Mondesire-Crump I, Gavrilovic IT. Temozolomide or bevacizumab for spinal high-grade gliomas. J Neurooncol. 2012;109(2):385–9.PubMedCrossRefGoogle Scholar
  61. 61.
    Yanamadala V, Koffie RM, Shankar GM, et al. Spinal cord glioblastoma: 25years of experience from a single institution. J Clin Neurosci. 2016;27:138–41.PubMedCrossRefGoogle Scholar
  62. 62.
    Cairncross G, Wang M, Shaw E, et al. Phase III trial of chemoradiotherapy for anaplastic oligodendroglioma: long-term results of RTOG 9402. J Clin Oncol. 2013;31(3):337–42.PubMedCrossRefGoogle Scholar
  63. 63.
    Henson JW, Thornton AF, Louis DN. Spinal cord astrocytoma: response to PCV chemotherapy. Neurology. 2000;54(2):518–20.PubMedCrossRefGoogle Scholar
  64. 64.
    Tobin MK, Geraghty JR, Engelhard HH, et al. Intramedullary spinal cord tumors: a review of current and future treatment strategies. Neurosurg Focus. 2015;39(2):E14.PubMedCrossRefGoogle Scholar
  65. 65.
    Chun HC, Schmidt-Ullrich RK, Wolfson A, et al. External beam radiotherapy for primary spinal cord tumors. J Neurooncol. 1990;9(3):211–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Radiation OncologyUniversity of California, Los AngelesLos AngelesUSA

Personalised recommendations