BACKGROUND: There is no standard therapy for surgery- and radiotherapy-resistant, recurrent, low-grade spinal cord gliomas. Therefore, a retrospective study of temozolomide (TMZ) in adults with recurrent low-grade spinal cord gliomas with a primary objective of determining progression-free survival (PFS) was performed. METHODS: Twenty-two patients (11 men and 11 women) aged 20 years to 55 years (median, 35 years) with recurrent spinal cord gliomas (World Health Organization grade 2 astrocytoma in 19 patients and oligoastrocytoma in 3 patients) were treated. All had previously been treated with surgery and involved-field radiotherapy. Thirteen patients underwent repeat surgery. All patients were chemotherapy-naive. TMZ was administered at a dose of 150-200 mg/m(2)/day for 5 consecutive days every 4 weeks (operationally defined as a single cycle). Neurologic and neuroradiographic evaluations were performed every 8 weeks. RESULTS: All patients were evaluable for toxicity and response. A total of 266 cycles of TMZ (median, 14 cycles; range, 2 cycles-24 cycles) was administered. TMZ-related toxicity included constipation (9 patients, 1 with grade 3), lymphopenia (9 patients, 1 with grade 3), fatigue (7 patients, 1 with grade 3), neutropenia (6 patients, 2 with grade 3), and thrombocytopenia (6 patients, 2 with grade 3). Four (18%) patients demonstrated a partial radiographic response, 12 (55%) demonstrated stable disease, and 6 (27%) had progressive disease after 2 cycles of TMZ. Time to tumor progression ranged from 2 months to 28 months (median, 14.5 months). Survival ranged from 4 months to 39 months (median, 23 months). PFS at 6 months, 12 months, 18 months, and 24 months was 64%, 64%, 41%, and 27%, respectively. CONCLUSIONS: TMZ demonstrated modest efficacy with acceptable toxicity in this cohort of adult patients with recurrent low-grade spinal cord gliomas. (c) 2008 American Cancer Society.