Temozolomide for malignant primary spinal cord glioma: an experience of six cases and a literature review |
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Authors: | Wook-Ha Kim Sang Hoon Yoon Chae-Yong Kim Ki-jeong Kim Min Mi Lee Gheeyoung Choe In-Ah Kim Jee Hyun Kim Yu Jung Kim Hyun-Jib Kim |
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Institution: | (1) Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Seoul, 463-707, Korea;(2) Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea;(3) Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea;(4) Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea |
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Abstract: | Malignant primary spinal cord gliomas (PSCGs) are rare, and the optimal treatment for these lesions remains controversial.
We report herein treatment outcomes of six malignant PSCGs managed with temozolomide (TMZ)-based multidisciplinary treatment.
TMZ was administered concomitantly with fractionated radiotherapy for two newly diagnosed primary spinal cord glioblastoma
multiforme (GBM), followed by adjuvant chemotherapy with TMZ. For one anaplastic astrocytoma (AA) and one anaplastic ependymoma
(AEPN), TMZ was given as adjuvant therapy at first recurrence. One malignantly transformed ependymoma (EPN) and one malignantly
transformed diffuse astrocytoma (DA) were treated with TMZ after radiotherapy at second recurrence. Two patients with newly
diagnosed GBM died, 12 and 16 months, respectively, after being treated with TMZ, during and after radiation therapy. One
patient with AA and one with malignantly transformed EPN showed good response to salvage therapy with TMZ and had stable disease
21 and 20 months, respectively, after TMZ treatment. One patient with recurrent AEPN and one with malignantly transformed
DA died from uncontrolled progression of the lesions despite TMZ chemotherapy. Three patients developed grade 1 or 2 neutropenia,
anemia, and infection. Nonhematologic toxicities occurred in all patients; however, they were below grade 3 in severity. TMZ
treatment may have a positive effect on control of malignant PSCGs and survival for some patients. Specifically, treatment
with TMZ during and after radiation therapy might provide survival benefit to patients with primary spinal cord GBM. A multicenter
cooperative investigation for a large-scale study on malignant PSCGs may be required. |
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