title: Radiotherapy of spinal cord gliomas : A retrospective mono-institutional analysis.
abstract: BACKGROUND
  Due to the rarity of spinal cord gliomas, no consensus has been reached regarding the optimal treatment strategy. The aim of the present retrospective study was to identify patient and tumor characteristics and to evaluate the effectiveness of radiotherapy within this setting.
  
  
  METHODS
  Patients diagnosed with spinal cord gliomas between 2003 and 2013 and treated at the Department of Radiation Oncology, University of Munich, were retrospectively analyzed. Overall survival was estimated with the Kaplan-Meier method and univariate analysis was performed by log-rank testing.
  
  
  RESULTS
  A total of 16 patients were identified. The cohort consisted of seven primary spinal cord gliomas and eight cases of metastases of cerebral gliomas. Median follow-up was 42 months and median total radiation dose was 45.0 Gy. In all, 62.5 % of patients received a simultaneous chemotherapy with temozolomide. The median overall survival was 6 months (95% CI: 0-27.5 months). Surgical resection of the tumor was a significant predictor of improved survival, compared with radiotherapy alone (p = 0.001). Patients with the diagnosis of a primary spinal cord glioma survived significantly longer than those presenting with a metastatic deposit from a cerebral glioma (p < 0.001). A statistically significant dose-response relationship at dose levels of ≥ 45 Gy vs. < 45 Gy could be derived (p < 0.001). Simultaneous chemotherapy did not influence survival outcome.
  
  
  CONCLUSIONS
  Despite the aggressive treatment in the present study, the prognosis for spinal cord gliomas was still poor, with a median overall survival of 6 months. To the best of our knowledge, this is the largest study reporting the results of simultaneous chemoradiation in spinal cord gliomas. A combined chemoradiation treatment seems feasible and can be considered as a new treatment option in the management of spinal cord gliomas.
authors.affiliation: Department of Radiation Oncology, University of Munich, Marchioninistr. 15, 81377, Munich, Germany. stefanie.corradini@med.uni-muenchen.de.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Corradini
authors.affiliation: Department of Radiation Oncology, University of Munich, Marchioninistr. 15, 81377, Munich, Germany.
authors.forename: Indrawati
authors.initials: I
authors.lastname: Hadi
authors.affiliation: Department of Radiation Oncology, Marienhospital Stuttgart, Böheimstraße 37, 70199, Stuttgart, Germany.
authors.forename: Vinzent
authors.initials: V
authors.lastname: Hankel
authors.affiliation: Department of Radiology, Neuroradiology, and Nuclear Medicine, Städtisches Klinikum München Harlaching, Sanatoriumsplatz 2, 81545, Munich, Germany.|Department of Neuroradiology, University of Munich, Marchioninistr. 15, 81377, Munich, Germany.
authors.forename: Lorenz
authors.initials: L
authors.lastname: Ertl
authors.affiliation: Department of Radiation Oncology, University of Munich, Marchioninistr. 15, 81377, Munich, Germany.
authors.forename: Ute
authors.initials: U
authors.lastname: Ganswindt
authors.affiliation: Department of Radiation Oncology, University of Munich, Marchioninistr. 15, 81377, Munich, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Belka
authors.affiliation: Department of Radiation Oncology, University of Munich, Marchioninistr. 15, 81377, Munich, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Niyazi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D005858:Germany / Q000453:epidemiology; D005910:Glioma / Q000401:mortality* / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D020266:Radiotherapy, Conformal / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D013120:Spinal Cord Neoplasms / Q000401:mortality* / Q000532:radiotherapy*; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
keywords: Chemoradiation; Outcome; Radiotherapy; Spinal cord glioma; Temozolomide