Primary spinal cord tumors of childhood: effects of clinical presentation, radiographic features, and pathology on survival.
To determine the relationship between clinical presentation, radiographic features, pathology, and treatment on overall survival of newly diagnosed pediatric primary spinal cord tumors (PSCT). Retrospective analysis of all previously healthy children with newly diagnosed PSCT at a single institution from 1995 to present was performed. Twenty-five pediatric patients (15 boys, average 7.9 years) were diagnosed with PSCT. Presenting symptoms ranged from 0.25 to 60 months (average 7.8 months). Symptom duration was significantly shorter for high grade tumors (average 1.65 months) than low grade tumors (average 11.2 months) (P = 0.05). MRI revealed tumor (8 cervical, 17 thoracic, 7 lumbar, 7 sacral) volumes of 98-94,080 mm(3) (average 19,474 mm(3)). Homogeneous gadolinium enhancement on MRI correlated with lower grade pathology (P = 0.003). There was no correlation between tumor grade and volume (P = 0.63) or edema (P = 0.36) by MRI analysis. Median survival was 53 months and was dependent on tumor grade (P = 0.05) and gross total resection (P = 0.01) but not on gender (P = 0.49), age of presentation (P = 0.82), duration of presenting symptoms (P = 0.33), or adjuvant therapies (P = 0.17). Stratified Kaplan-Meier analysis confirmed the association between degree of resection and survival after controlling for tumor grade (P = 0.01). MRI homogeneous gadolinium enhancement patterns may be helpful in distinguishing low grade from high grade spinal cord malignancies. While tumor grade and gross total resection rather than duration of symptoms correlated with survival in our series, greater than one-third of patients had reported symptoms greater than 6 months duration prior to diagnosis.
Crawford
John R
JR
Department of Neurology, Children's National Medical Center, The George Washington University, Washington, DC, USA. jrcrawford@ucsd.edu.|The Brain Tumor Institute, Children's National Medical Center, The George Washington University, Washington, DC, USA. jrcrawford@ucsd.edu.|University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0662, USA. jrcrawford@ucsd.edu.
Zaninovic
Alejandra
A
Department of Radiology, Children's National Medical Center, The George Washington University, Washington, DC, USA.
Santi
Mariarita
M
Department of Pathology, Children's National Medical Center, The George Washington University, Washington, DC, USA.|Department of Neurosurgery, Children's National Medical Center, The George Washington University, Washington, DC, USA.
Rushing
Elisabeth J
EJ
The Department of Neuropathology and Ophthalmic Pathology, Armed Forces Institute of Pathology, Washington, DC, USA.
Olsen
Cara H
CH
The Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Keating
Robert F
RF
Department of Pathology, Children's National Medical Center, The George Washington University, Washington, DC, USA.|Department of Neurosurgery, Children's National Medical Center, The George Washington University, Washington, DC, USA.|The Brain Tumor Institute, Children's National Medical Center, The George Washington University, Washington, DC, USA.
Vezina
Gilbert
G
Department of Radiology, Children's National Medical Center, The George Washington University, Washington, DC, USA.|The Brain Tumor Institute, Children's National Medical Center, The George Washington University, Washington, DC, USA.
Kadom
Nadja
N
Department of Radiology, Children's National Medical Center, The George Washington University, Washington, DC, USA.|The Brain Tumor Institute, Children's National Medical Center, The George Washington University, Washington, DC, USA.
Packer
Roger J
RJ
Department of Neurology, Children's National Medical Center, The George Washington University, Washington, DC, USA.|The Brain Tumor Institute, Children's National Medical Center, The George Washington University, Washington, DC, USA.
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005682:Gadolinium; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D013120:Spinal Cord Neoplasms / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D015996:Survival Rate
D005682:Gadolinium