Contribution of temozolomide chemotherapy for intramedullary grade II spinal cord astrocytomas in adults: Our experience

Introduction. - Grade II intramedullary astrocytomas are rare tumors. Despite a well-defined role of adjuvant temozolomide chemotherapy for brain gliomas, the contribution of this therapy for intramedullary gliomas is not yet clearly defined. Method. - We retrospectively analyzed the data of 5 adult patients treated with temozolomide between 2008 and 2015 for a grade II intramedullary astrocytoma with progression after surgery. Results. - Five patients from 19 to 70 years of age (median, 37 years) underwent a second surgery for the progression of a grade II intramedullary astrocytoma (median progression-free survival 26 months [8-901). All tumors remained grade II. Due to a second clinical or/and radiological tumor progression, the patients were treated with temozolomide after a 37 months median progression-free survival (5-66). All patients received at minimum 12 cycles (mean 14 5; range 12-24) of temozolomide (150-200 mg/m(2)/day, 5 days/28 days). All patients were alive after a 10-year median follow-up after diagnosis (6-13). All patients were able to walk except one, who was previously in McCormick autonomy grade IV before chemotherapy. The McCormick autonomy rating after temozolomide was stable for 4 patients and improved for 1 patient. The treatment was delayed once for hematological toxicity. Conclusion. - Temozolomide stabilized all 5 patients without any major toxicity. Based on this experience that needs to be confirmed, we consider that temozolomide should be envisaged within the therapeutic arsenal for progressive intramedullary grade II astrocytomas. (C) 2017 Elsevier Masson SAS. All rights reserved.