Management of intramedullary spinal cord tumors.

Abstract

From Jan. 1962-May 1979, 23 patients with biopsy-proved intramedullary spinal cord tumors were treated initially with total resection, subtotal resection, irradiation or subtotal resection and irradiation. Local control was achieved in 1/2 patients after total resection, 1/3 after subtotal resection, 8/9 after subtotal resection and radiation therapy and 5/8 after radiation therapy alone. The patients with ependymomas exhibited a radiation dose-response relationship. Of 8 patients followed 5 or more yr postirradiation, local control was achieved in 2/3 with time dose fraction (TDF) < 55, 2/3 with TDF 55-65, and 2/2 with TDF > 65. The actuarial 5 and 10 yr survival rates were 58 and 23% for astrocytoma and 100 and 73% for patients with ependymoma, respectively. Neurological deficits improved or became totally normal after initial irradiation. Patterns of failure, management of recurrences and radiotherapeutic techniques and dose recommendations are discussed.