Clinical characteristics and prognosis of Glioblastoma patients with infratentorial recurrence

Abstract

Background Glioblastoma (GBM) infrequently recurs in the infratentorial region. Such Infratentorial recurrence (ITR) has some clinically unique characteristics, such as presenting unspecific symptoms and providing patients a chance to receive additional radiotherapy. However, the clinical significances of ITR are not well studied. Methods We reviewed newly diagnosed isocitrate dehydrogenase (IDH)-wildtype GBM patients treated at our institution between October 2008 and December 2018. ITR was defined as any type of recurrence in GBM, including dissemination or distant recurrence, which primarily developed in the supratentorial region and recurred in the infratentorial region. Results Of 134 patients with newly diagnosed IDH-wildtype GBM, six (4.5%) were classified as having ITR. There was no significant difference in median duration from the first surgery to ITR development between patients with and without ITR (12.2 vs. 10.2 months, P = 0.65). The primary symptoms of ITR were gait disturbance (100%, n = 6), dizziness (50.0%, n = 3), nausea (33.3%, n = 2), and cerebellar mutism (16.7%, n = 1). In four cases (66.7%), symptoms were presented before ITR development. All patients received additional treatments for ITR. The median post-recurrence survival (PRS) of ITR patients was significantly shorter than that of general GBM patients (5.5 vs. 9.1 months, P = 0.023). However, chemoradiotherapy contributed to palliating symptoms such as nausea. Conclusions ITR is a severe recurrence type in GBM patients. Its symptoms are neurologically unspecific and can be overlooked or misdiagnosed as side effects of treatments. Carefully checking the infratentorial region, especially around the fourth ventricle, is essential during the GBM patient follow-up.

Distant recurrence in the cerebellar dentate nucleus through the dentato-rubro-thalamo-cortical pathway in supratentorial glioma cases

“…Kawauchi et al reported a case series of cerebellar recurrence from supratentorial lesions and described that the recurrence might develop along the DRTC pathway [ 14 ]. In this study, we hypothesized that recurrence in the DN developed along the DRTC pathway based on the anatomical background of the DN.…”

“…First, the predominant tumor location of the primary tumor was clarified. To the best of our knowledge, 10 cases of adult diffuse gliomas with recurrence in the DN have been reported in the literature [ 4 , 7 , 12 , 14 ]. Primary lesions in these cases were located at the frontal lobe in seven cases, thalamus in one case, and temporal lobe in one case [ 4 , 7 , 14 ].…”

“…Adult diffuse gliomas and diffuse midline gliomas, H3 K27-altered (DMG) are infiltrative tumors [ 20 ]. They occasionally recur at distant sites, including the cerebellum, brainstem, or intramedullary region of the spinal cord, and this distant recurrence is associated with poor prognosis [ 1 , 8 , 12 , 14 , 29 , 36 ]. Therefore, attention should be paid to the vicinity of the resection cavity and the entire central nervous system.…”

“…Distant recurrence can develop in the cerebellum [ 4 , 5 , 7 , 10 ]. This type of recurrence has been considered to occur due to dissemination through the CSF [ 4 , 7 , 12 , 14 ]. However, no reports have demonstrated a correlation between cytological findings and cerebellar recurrence.…”

“…However, no reports have demonstrated a correlation between cytological findings and cerebellar recurrence. Cerebellar recurrence frequently develops at the hilus of the cerebellar dentate nucleus (DN) [ 4 , 7 , 12 , 14 ]. Based on these findings, we hypothesize that distant cerebellar recurrence from a supratentorial lesion occurs through the white matter tracts that connect the cerebellar DN with the cerebrum and thalamus.…”