title: Spinal cord glioblastoma: 25years of experience from a single institution.
abstract: Accounting for less than 0.2% of all glioblastomas, high grade gliomas of the spinal cord are very rare. Here, we discuss our approach to managing patients with high grade spinal cord glioma and review the literature on the subject. Six patients with high grade spinal cord gliomas who presented to our institution between 1990 and 2015 were reviewed. Each patient underwent subtotal surgical resection, with a subset receiving adjuvant chemotherapy and radiation. Our primary outcomes of interest were pre-operative and post-operative functional status. One year survival rate was 100%. All patients had stable or improved American Spine Injury Association score immediately after surgery, which was maintained at 3months in 83.3% of patients. Karnofsky Performance Status (KPS) was stable at 3month follow up in 50% of patients, but all had decreased KPS 1year after surgery. A subset of patients received post-operative radiation and chemotherapy with 0% tumor recurrence rate at 3months. We assessed the molecular profiles of tumors from two patients in our series and found that each had mutations in TP53, but had wildtype BRAF, IDH-1, and MGMT. Taken together, our data show that patients with high grade spinal cord gliomas have an excellent survival at 1year, but with some decline in functional status within this period. Further studies are needed to elucidate the natural history of the disease and to explore the role of adjuvant targeted molecular therapies.
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital, 15 Parkman Street, WACC 021, Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA. Electronic address: vyanamadala@mgh.harvard.edu.
authors.forename: Vijay
authors.initials: V
authors.lastname: Yanamadala
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital, 15 Parkman Street, WACC 021, Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Koffie
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital, 15 Parkman Street, WACC 021, Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Ganesh M
authors.initials: GM
authors.lastname: Shankar
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital, 15 Parkman Street, WACC 021, Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Jay I
authors.initials: JI
authors.lastname: Kumar
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital, 15 Parkman Street, WACC 021, Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Quinlan D
authors.initials: QD
authors.lastname: Buchlak
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital, 15 Parkman Street, WACC 021, Boston, MA 02115, USA.
authors.forename: Vidya
authors.initials: V
authors.lastname: Puthenpura
authors.affiliation: Department of Pathology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Frosch
authors.affiliation: Department of Pathology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Gudewicz
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital, 15 Parkman Street, WACC 021, Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Lawrence F
authors.initials: LF
authors.lastname: Borges
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital, 15 Parkman Street, WACC 021, Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: John H
authors.initials: JH
authors.lastname: Shin
mesh_terms: D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D019175:DNA Methylation; D005260:Female; D005909:Glioblastoma / Q000235:genetics / Q000601:surgery / Q000628:therapy*; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000235:genetics; D009364:Neoplasm Recurrence, Local; D048493:Proto-Oncogene Proteins B-raf / Q000235:genetics / Q000378:metabolism; D020127:Recovery of Function; D013120:Spinal Cord Neoplasms / Q000235:genetics / Q000601:surgery / Q000628:therapy*; D016019:Survival Analysis; D016896:Treatment Outcome; D016159:Tumor Suppressor Protein p53 / Q000235:genetics / Q000378:metabolism
chemical_list: D009363:Neoplasm Proteins; C495901:TP53 protein, human; D016159:Tumor Suppressor Protein p53; C482119:BRAF protein, human; D048493:Proto-Oncogene Proteins B-raf
keywords: Glioblastoma; Spinal cord; Spinal cord glioblastoma