Cordotomy for patients with thoracic malignant astrocytoma

Clinical article

Masaya Nakamura, Osahiko Tsuji, Kanehiro Fujiyoshi, Kota Watanabe, Takashi Tsuji, Ken Ishii, Morio Matsumoto, Yoshiaki Toyama, Kazuhiro Chiba

研究成果: Article

7 引用 (Scopus)

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Object. The optimal management of malignant astrocytomas remains controversial, and the prognosis of these lesions has been dismal regardless of the administered treatment. In this study the authors investigated the surgical outcomes of cordotomy in patients with thoracic malignant astrocytomas to determine the effectiveness of this procedure. Methods. Cordotomy was performed in 5 patients with glioblastoma multiforme (GBM) and 2 with anaplastic astrocytoma (AA). A Kaplan-Meier survival analysis was performed, and the associations of the resection level with survival and postoperative complications were retrospectively examined. Results. Cordotomy was performed in a single stage in 2 patients with GBM and in 2 stages in 3 patients with GBM and 2 patients with AA. In the 2 patients with GBM, cordotomy was performed 2 and 3 weeks after a partial tumor resection. In the 2 patients with AA, the initial treatment consisted of partial tumor resection and subtotal resection combined with radiotherapy, and rostral tumor growth and progressive paralysis necessitated cordotomy 2 and 28 months later. One patient with a secondary GBM underwent cordotomy; the GBM developed 1 year after subtotal resection and radiotherapy for a WHO Grade II astrocytoma. Four patients died 4, 5, 24, and 42 months after the initial operation due to CSF dissemination, and 3 patients (2 with GBM and 1 with AA) remain alive (16, 39, and 71 months). No metastasis to any other organs was noted. Conclusions. One-stage cordotomy should be indicated for patients with thoracic GBM or AA presenting with complete paraplegia preoperatively. In patients with thoracic GBM, even if paralysis is incomplete, cordotomy should be performed before the tumor disseminates through the CSF. Radical resection should be attempted in patients with AA and incomplete paralysis. If the tumor persists, radiotherapy and chemotherapy are indicated, and cordotomy should be reserved for lesions growing progressively after such second-line treatments.

元の言語English
ページ(範囲)418-423
ページ数6
ジャーナルJournal of Neurosurgery: Spine
13
発行部数4
DOI
出版物ステータスPublished - 01-01-2010

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Cordotomy
Astrocytoma
Thorax
Glioblastoma
Paralysis
Radiotherapy
Neoplasms
Paraplegia
Kaplan-Meier Estimate
Survival Analysis

All Science Journal Classification (ASJC) codes

  • Surgery
  • Neurology
  • Clinical Neurology

これを引用

Nakamura, M., Tsuji, O., Fujiyoshi, K., Watanabe, K., Tsuji, T., Ishii, K., ... Chiba, K. (2010). Cordotomy for patients with thoracic malignant astrocytoma: Clinical article. Journal of Neurosurgery: Spine, 13(4), 418-423. https://doi.org/10.3171/2010.4.SPINE09901
Nakamura, Masaya ; Tsuji, Osahiko ; Fujiyoshi, Kanehiro ; Watanabe, Kota ; Tsuji, Takashi ; Ishii, Ken ; Matsumoto, Morio ; Toyama, Yoshiaki ; Chiba, Kazuhiro. / Cordotomy for patients with thoracic malignant astrocytoma : Clinical article. :: Journal of Neurosurgery: Spine. 2010 ; 巻 13, 番号 4. pp. 418-423.
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abstract = "Object. The optimal management of malignant astrocytomas remains controversial, and the prognosis of these lesions has been dismal regardless of the administered treatment. In this study the authors investigated the surgical outcomes of cordotomy in patients with thoracic malignant astrocytomas to determine the effectiveness of this procedure. Methods. Cordotomy was performed in 5 patients with glioblastoma multiforme (GBM) and 2 with anaplastic astrocytoma (AA). A Kaplan-Meier survival analysis was performed, and the associations of the resection level with survival and postoperative complications were retrospectively examined. Results. Cordotomy was performed in a single stage in 2 patients with GBM and in 2 stages in 3 patients with GBM and 2 patients with AA. In the 2 patients with GBM, cordotomy was performed 2 and 3 weeks after a partial tumor resection. In the 2 patients with AA, the initial treatment consisted of partial tumor resection and subtotal resection combined with radiotherapy, and rostral tumor growth and progressive paralysis necessitated cordotomy 2 and 28 months later. One patient with a secondary GBM underwent cordotomy; the GBM developed 1 year after subtotal resection and radiotherapy for a WHO Grade II astrocytoma. Four patients died 4, 5, 24, and 42 months after the initial operation due to CSF dissemination, and 3 patients (2 with GBM and 1 with AA) remain alive (16, 39, and 71 months). No metastasis to any other organs was noted. Conclusions. One-stage cordotomy should be indicated for patients with thoracic GBM or AA presenting with complete paraplegia preoperatively. In patients with thoracic GBM, even if paralysis is incomplete, cordotomy should be performed before the tumor disseminates through the CSF. Radical resection should be attempted in patients with AA and incomplete paralysis. If the tumor persists, radiotherapy and chemotherapy are indicated, and cordotomy should be reserved for lesions growing progressively after such second-line treatments.",
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Nakamura, M, Tsuji, O, Fujiyoshi, K, Watanabe, K, Tsuji, T, Ishii, K, Matsumoto, M, Toyama, Y & Chiba, K 2010, 'Cordotomy for patients with thoracic malignant astrocytoma: Clinical article', Journal of Neurosurgery: Spine, 巻. 13, 番号 4, pp. 418-423. https://doi.org/10.3171/2010.4.SPINE09901

Cordotomy for patients with thoracic malignant astrocytoma : Clinical article. / Nakamura, Masaya; Tsuji, Osahiko; Fujiyoshi, Kanehiro; Watanabe, Kota; Tsuji, Takashi; Ishii, Ken; Matsumoto, Morio; Toyama, Yoshiaki; Chiba, Kazuhiro.

:: Journal of Neurosurgery: Spine, 巻 13, 番号 4, 01.01.2010, p. 418-423.

研究成果: Article

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T1 - Cordotomy for patients with thoracic malignant astrocytoma

T2 - Clinical article

AU - Nakamura, Masaya

AU - Tsuji, Osahiko

AU - Fujiyoshi, Kanehiro

AU - Watanabe, Kota

AU - Tsuji, Takashi

AU - Ishii, Ken

AU - Matsumoto, Morio

AU - Toyama, Yoshiaki

AU - Chiba, Kazuhiro

PY - 2010/1/1

Y1 - 2010/1/1

N2 - Object. The optimal management of malignant astrocytomas remains controversial, and the prognosis of these lesions has been dismal regardless of the administered treatment. In this study the authors investigated the surgical outcomes of cordotomy in patients with thoracic malignant astrocytomas to determine the effectiveness of this procedure. Methods. Cordotomy was performed in 5 patients with glioblastoma multiforme (GBM) and 2 with anaplastic astrocytoma (AA). A Kaplan-Meier survival analysis was performed, and the associations of the resection level with survival and postoperative complications were retrospectively examined. Results. Cordotomy was performed in a single stage in 2 patients with GBM and in 2 stages in 3 patients with GBM and 2 patients with AA. In the 2 patients with GBM, cordotomy was performed 2 and 3 weeks after a partial tumor resection. In the 2 patients with AA, the initial treatment consisted of partial tumor resection and subtotal resection combined with radiotherapy, and rostral tumor growth and progressive paralysis necessitated cordotomy 2 and 28 months later. One patient with a secondary GBM underwent cordotomy; the GBM developed 1 year after subtotal resection and radiotherapy for a WHO Grade II astrocytoma. Four patients died 4, 5, 24, and 42 months after the initial operation due to CSF dissemination, and 3 patients (2 with GBM and 1 with AA) remain alive (16, 39, and 71 months). No metastasis to any other organs was noted. Conclusions. One-stage cordotomy should be indicated for patients with thoracic GBM or AA presenting with complete paraplegia preoperatively. In patients with thoracic GBM, even if paralysis is incomplete, cordotomy should be performed before the tumor disseminates through the CSF. Radical resection should be attempted in patients with AA and incomplete paralysis. If the tumor persists, radiotherapy and chemotherapy are indicated, and cordotomy should be reserved for lesions growing progressively after such second-line treatments.

AB - Object. The optimal management of malignant astrocytomas remains controversial, and the prognosis of these lesions has been dismal regardless of the administered treatment. In this study the authors investigated the surgical outcomes of cordotomy in patients with thoracic malignant astrocytomas to determine the effectiveness of this procedure. Methods. Cordotomy was performed in 5 patients with glioblastoma multiforme (GBM) and 2 with anaplastic astrocytoma (AA). A Kaplan-Meier survival analysis was performed, and the associations of the resection level with survival and postoperative complications were retrospectively examined. Results. Cordotomy was performed in a single stage in 2 patients with GBM and in 2 stages in 3 patients with GBM and 2 patients with AA. In the 2 patients with GBM, cordotomy was performed 2 and 3 weeks after a partial tumor resection. In the 2 patients with AA, the initial treatment consisted of partial tumor resection and subtotal resection combined with radiotherapy, and rostral tumor growth and progressive paralysis necessitated cordotomy 2 and 28 months later. One patient with a secondary GBM underwent cordotomy; the GBM developed 1 year after subtotal resection and radiotherapy for a WHO Grade II astrocytoma. Four patients died 4, 5, 24, and 42 months after the initial operation due to CSF dissemination, and 3 patients (2 with GBM and 1 with AA) remain alive (16, 39, and 71 months). No metastasis to any other organs was noted. Conclusions. One-stage cordotomy should be indicated for patients with thoracic GBM or AA presenting with complete paraplegia preoperatively. In patients with thoracic GBM, even if paralysis is incomplete, cordotomy should be performed before the tumor disseminates through the CSF. Radical resection should be attempted in patients with AA and incomplete paralysis. If the tumor persists, radiotherapy and chemotherapy are indicated, and cordotomy should be reserved for lesions growing progressively after such second-line treatments.

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