1566 / 1708
from any cause, progression-free survival (PFS) the
time from diagnosis to a first recurrence of disease (i.e.,
local or distant metastasis), and local tumor control
(LC) the time from diagnosis to first local failure.
Results
Patient characteristics
Patient characteristics are summarized in Table 1. Of
the 35 patients, 25 were males. The median age at
diagnosis was 35 years. The most common presenting
symptom was low back pain (94%). The median
duration of symptoms before diagnosis was 12 months.
The median KPS was 80. The most common initial
imaging modality was MRI in 29 patients (83%). In 21
patients (60%) tumor location was lumbosacral/cauda
equina region.
Treatment results
Surgery was the initial treatment in all patients. GTR
was achieved in 21 patients (60%), STR in 13 (37%),
and a biopsy only in 1 patient (3%). A total of 13
patients were observed after their surgery. These pa-
tients included 11 patients who underwent GTR and 2
who underwent STR.
RT was given adjuvantly after surgery to 22 patients
(63%) and as salvage treatment of recurrent disease to
7 (20%). The median time to the start of adjuvant
RT from the date of surgery was 47 days (range,
21–140 days). The total RT dose ranged from 44.3 to
56 Gy (median, 50.4 Gy), and the dose per fraction
ranged from 1.5 Gy to 2 Gy (median, 1.8 Gy). In 13
patients, a cone-down field was used for the last med-
ian 9 Gy (range, 3.6–13.5 Gy).
A total of five patients underwent craniospinal
irradiation (CSI) prescribed to a median dose of
39.6 Gy (range, 39.6–41 Gy) plus a median 10.8 Gy
(range, 9–13.5 Gy) boost to the tumor bed for lepto-
meningeal disease (LMD). One of the patients
received CSI at the time of diagnosis of LMD. The
remaining four patients had initially received local
RT to the spine at diagnosis and subsequently were
retreated with CSI due to recurrence of LMD.
Survival and local control
The median follow-up time was 10.7 years (range,
3–33 years). The OS rate at both 5 and 10 years was
97% (Fig. 1). Three patients died during the follow-up
period. One died of MPE and the others of unknown
causes 15 years after the initial diagnosis. There were
12 (34%) recurrences in the study population. The
median time to disease recurrence was 65 months
(range, 5–378 months). The 5- and 10-year PFS rates
were 70% and 62%, respectively (Fig. 2), and 5- and
10-year LC rates were 76% and 72%, respectively.
The influence on survival of both clinical and
treatment variables was also examined. The prognostic
variables we studied included age, Karnofsky perfor-
mance status, duration of symptoms prior to diagnosis,
tumor location, extent of surgery, initial treatment
modality, and total RT dose. There were no statisti-
cally significant associations between the prognostic
variables and OS rate. However, older patient age
(
£
35 years vs. >35 years) (
P
= 0.002) and initial treat-
ment modality (surgery vs. surgery + adjuvant RT)
significantly affected PFS (Fig. 3;
P
= 0.04) for the
entire study group. The 5- and 10-year PFS rates for all
patients who received adjuvant RT were 82% and
Table 1
Patient characteristics and treatment details
Variable
Number
a
Number of patients
35
Age, years
Median
35
Range
14–63
KPS
b
Median
80
Range
50–100
Gender
Female/Male
10/25
Symptoms
Low back pain
33 (94%)
Extremity numbness
15 (43%)
Extremity weakness
6 (17%)
Urinary dysfunction
5 (14%)
Abnormal gait
3 (9%)
Symptom duration, months
Median
12
Range
1–84
Imaging modality
Myelography
5 (14%)
CT
1 (3%)
MRI
29 (83%)
Tumor location
Thoracolumbar
14 (40%)
Lumbosacral/cauda equina
21 (60%)
Extent of surgery
Gross total resection
21 (60%)
Subtotal resection
13 (37%)
Biopsy only
1 (3%)
Primary treatment
Surgery
13 (37%)
Surgery + RT
22 (63%)
a
Data are presented as number of patients unless otherwise
indicated
b
KPS, Karnofsky performance status
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