2d) Gliomas of the Spinal Cord


Astrocytoma represents 40% of primary intramedullary spinal cord tumours. In children they are mostly WHO grade I - II lesions (pilocytic astrocytoma, diffuse fibrillary astrocytoma) whereas higher grade tumours occur with higher frequency in adults. Prognosis for WHO Grade I lesions is typically excellent with 80% 5 year survival. Median survival for Grade III-IV lesions is 6 months.


Gross total resection is the aim but is only achieved for WHO grade I lesions. In this setting adjuvant treatment is not indicated.
Other patients should receive adjuvant radiotherapy. Doses and volumes are typically based on the cerebral equivalents of tumours. Dose ranges from 50.4 Gy (low grade) to 54-60 Gy for high grade tumours. The volume is typically the pre-operative GTV with a 2 cm expansion to PTV.


Ependymoma represents another 50% of intramedullary spinal cord tumours.