Symptomatic spinal dissemination of malignant astrocytoma.
OBJECTIVE
Symptomatic spinal dissemination of malignant astrocytoma is rarely found except at autopsy. This study evaluated the clinical incidence and characteristics of spinal dissemination and the effect on outcome.


METHODS
Patients treated for primary malignant astrocytoma, including 33 with anaplastic astrocytoma and 35 with glioblastoma, at our department between 1997 and 1999 were followed up until April 30, 2001. Head magnetic resonance (MR) imaging of all patients was obtained every 2-3 months. Signs and symptoms of leptomeningeal spread were checked at monthly outpatient examinations. Spinal MR imaging was performed if any symptoms indicating spinal dissemination were found.


RESULTS
Median survival times of patients with anaplastic astrocytoma and glioblastoma were 40.5 and 16.0 months, respectively. Seventeen patients (25%) developed intracranial dissemination and 15 of these died. Six patients (8.8%), one with anaplastic astrocytoma and five with glioblastoma, developed spinal dissemination. All patients with spinal dissemination also had intracranial dissemination. Five of the six patients died, despite systemic radiochemotherapy in four patients. All patients died of extensive whole brain and spinal dissemination or nodular mass enlargement at the upper cervical cord, not of local massive tumor progression.


CONCLUSIONS
Symptomatic spinal dissemination of malignant astrocytoma is not so rare, and is the cause of death. The relatively high incidence of symptomatic leptomeningeal dissemination must be considered in the treatment of malignant astrocytomas.
Saito
Ryuta
R
Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
Kumabe
Toshihiro
T
Jokura
Hidefumi
H
Shirane
Reizo
R
Yoshimoto
Takashi
T
D000293:Adolescent; D000328:Adult; D001254:Astrocytoma / Q000175:diagnosis* / Q000401:mortality / Q000556:secondary*; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D005909:Glioblastoma / Q000175:diagnosis / Q000556:secondary*; D006801:Humans; D007564:Japan; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000556:secondary*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D013125:Spinal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000556:secondary*; D015996:Survival Rate