Surgical outcomes of pediatric spinal cord astrocytomas: systematic review and meta-analysis
| Autor: | Samuel H. Cheshier, Rogelio Esparza, Cynthia J. Campen, Tej D. Azad, Anand Veeravagu, Ian D. Connolly, Gerald A. Grant, Swapnil Mehta, Amy Li, Paul G. Fisher, Michael S. B. Edwards, Yuhao Huang, James Pan, Arjun V Pendharkar |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Adolescent medicine.medical_treatment MEDLINE Astrocytoma Extent of resection Neurosurgical Procedures law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law medicine Humans Spinal Cord Neoplasms Child business.industry Subtotal Resection General Medicine medicine.disease Spinal cord Surgery Radiation therapy Treatment Outcome medicine.anatomical_structure Child Preschool 030220 oncology & carcinogenesis Meta-analysis Female business 030217 neurology & neurosurgery |
| Zdroj: | Journal of Neurosurgery: Pediatrics. 22:404-410 |
| ISSN: | 1933-0715 1933-0707 |
| Popis: | OBJECTIVEPediatric spinal astrocytomas are rare spinal lesions that pose unique management challenges. Therapeutic options include gross-total resection (GTR), subtotal resection (STR), and adjuvant chemotherapy or radiation therapy. With no randomized controlled trials, the optimal management approach for children with spinal astrocytomas remains unclear. The aim of this study was to conduct a systematic review and meta-analysis on pediatric spinal astrocytomas.METHODSThe authors performed a systematic review of the PubMed/MEDLINE electronic database to investigate the impact of histological grade and extent of resection on overall survival among patients with spinal cord astrocytomas. They retained publications in which the majority of reported cases included astrocytoma histology.RESULTSTwenty-nine previously published studies met the eligibility criteria, totaling 578 patients with spinal cord astrocytomas. The spinal level of intramedullary spinal cord tumors was predominantly cervical (53.8%), followed by thoracic (40.8%). Overall, resection was more common than biopsy, and GTR was slightly more commonly achieved than STR (39.7% vs 37.0%). The reported rates of GTR and STR rose markedly from 1984 to 2015. Patients with high-grade astrocytomas had markedly worse 5-year overall survival than patients with low-grade tumors. Patients receiving GTR may have better 5-year overall survival than those receiving STR.CONCLUSIONSThe authors describe trends in the management of pediatric spinal cord astrocytomas and suggest a benefit of GTR over STR for 5-year overall survival. |
| Databáze: | OpenAIRE |
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