Patterns of failure after radiation therapy in primary spinal high-grade gliomas: A single institutional analysis

Rituraj Upadhyay; Swapnil Khose; Halyna Pokhylevych; Arnold C Paulino; Mary Frances McAleer; Amol Ghia; Jing Li; Debra Nana Yeboa; Monica Loghin; Rebecca Harrison; Barbara O'Brien; Carlos Kamiya-Matsuoka; John De Groot; Vinay K Puduvalli; Claudio Tatsui; Christopher Alvarez-Breckenridge; Sujit Prabhu; Larry Rhines; Wafik Zaky; Frank Lin; Jeffery S Weinberg; Gregory Fuller; David I Sandberg; Jason Michael Johnson; Susan L McGovern

doi:10.1093/noajnl/vdac129

Patterns of failure after radiation therapy in primary spinal high-grade gliomas: A single institutional analysis

Neurooncol Adv. 2022 Aug 20;4(1):vdac129. doi: 10.1093/noajnl/vdac129. eCollection 2022 Jan-Dec.

Authors

Rituraj Upadhyay¹, Swapnil Khose², Halyna Pokhylevych², Arnold C Paulino³, Mary Frances McAleer³, Amol Ghia³, Jing Li³, Debra Nana Yeboa³, Monica Loghin⁴, Rebecca Harrison⁴, Barbara O'Brien⁴, Carlos Kamiya-Matsuoka⁴, John De Groot⁴, Vinay K Puduvalli⁴, Claudio Tatsui⁵, Christopher Alvarez-Breckenridge⁵, Sujit Prabhu⁵, Larry Rhines⁵, Wafik Zaky⁶, Frank Lin⁷, Jeffery S Weinberg⁵, Gregory Fuller⁸, David I Sandberg⁵, Jason Michael Johnson², Susan L McGovern³

Affiliations

¹ Department of Radiation Oncology, The James Cancer Centre, Ohio State University, Columbus, Ohio, USA.
² Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
³ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
⁴ Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
⁵ Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
⁶ Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
⁷ Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas, USA.
⁸ Department of Neuro-pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA (G.F.).

Abstract

Background: Primary spinal high-grade gliomas (S-HGG) are rare aggressive tumors; radiation therapy (RT) often plays a dominant role in management. We conducted a single-institution retrospective review to study the clinicopathological features and management of S-HGGs.

Methods: Patients with biopsy-proven S-HGG who received RT from 2001 to 2020 were analyzed for patient, tumor, and treatment characteristics. Kaplan-Meier estimates were used for survival analyses.

Results: Twenty-nine patients were identified with a median age of 25.9 years (range 1-74 y). Four patients had GTR while 25 underwent subtotal resection or biopsy. All patients were IDH wildtype and MGMT-promoter unmethylated, where available. H3K27M mutation was present in 5 out of 10 patients tested, while one patient harbored p53 mutation. Median RT dose was 50.4 Gy (range 39.6-54 Gy) and 65% received concurrent chemotherapy, most commonly temozolomide. Twenty-three (79%) of patients had documented recurrence. Overall, 16 patients relapsed locally, 10 relapsed in the brain and 8 developed leptomeningeal disease; only 8 had isolated local relapse. Median OS from diagnosis was 21.3 months and median PFS was 9.7 months. On univariate analysis, age, gender, GTR, grade, RT modality, RT dose and concurrent chemotherapy did not predict for survival. Patients with H3K27M mutation had a poorer PFS compared to those without mutation (10.1 m vs 45.1 m) but the difference did not reach statistical significance (P = .26).

Conclusions: The prognosis of patients with spinal HGGs remains poor with two-thirds of the patients developing distant recurrence despite chemoradiation. Survival outcomes were similar in patients ≤ 29 years compared to adults > 29 years. A better understanding of the molecular drivers of spinal HGGs is needed to develop more effective treatment options.

Keywords: high-grade glioma; proton therapy; radiation; spinal glioma.

Grants and funding

P30 CA016672/CA/NCI NIH HHS/United States