Intramedullary spinal cord astrocytomas in children

BACKGROUND: Intramedullary spinal cord astrocytomas are uncommon tumors in childhood. There is little information on therapy and outcome of astrocytomas in this location. PROCEDURE: A retrospective review was performed for the 10 children who were treated between 1996 and 2003 for spinal cord astrocytomas in our institution. Only one had metastatic disease. All ten patients underwent surgical resection, nine partial and one total. Eight had low-grade tumors, and two high-grade tumors. Two had surgery only, four had chemotherapy only, two had radiation only, and two had both radiation and chemotherapy. RESULTS: Progression free survival was 58% and survival was 68% at 4 years. Four patients had disease progression, of which three died. Both children with high-grade astrocytomas died. Two of eight of the children with low-grade astrocytomas of the cord recurred, one having received radiation as initial therapy and the other chemotherapy. The child, who relapsed after radiation, had a spastic quadriplegia from radiation myelitis and no salvage therapy was attempted. The four patients, all with low-grade astrocytomas, who treated with chemotherapy alone, received carboplatin and vincristine. Of these four, three are in continuous remission and one relapsed, but was salvaged with radiation. CONCLUSIONS: Chemotherapy and radiation did not benefit those with high-grade astrocytomas of the spinal cord. Good outcomes can be achieved by conservative surgery for low-grade astrocytomas of the cord when adjuvant therapy is given. Carboplatin and vincristine appeared to be effective, safe therapy for those with low-grade astrocytomas of the cord.