Extensive Leptomeningeal Intracranial and Spinal Metastases in a Patient with a Supratentorial Glioblastoma Multiforme, IDH-Wildtype

Schwartz, Christoph; Romagna, Alexander; Machegger, Lukas; Weiß, Lukas; Huemer, Florian; Fastner, Gerd; Kleindienst, Waltraud; Weis, Serge; Greil, Richard; Winkler, Peter

doi:10.1016/j.wneu.2018.09.082

Cited by 10 publications

(11 citation statements)

References 26 publications

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“…Progressive paraplegia [9, 27, 36, 69, 73, 83, 84], sphincter incontinence [1, 11, 36, 55, 80, 84], and spinal ataxia [20, 29, 80] were described when the spinal cord or cauda equina are involved [9, 29, 30, 33, 69, 73, 85, 86]. Isolated symptoms such as paresthesia, ataxia, back pain, and leg or shoulder pain are rare [27, 29, 87, 88].…”

Section: Clinical Presentationmentioning

confidence: 99%

“…The spatial proximity to ventricles and the tumor size were considered as risk factor of LMS, but existing data are conflicting [1, 6, 7, 11]. Indeed, invasive behavior of tumor cells and the environment of the subventricular zone have been pinpointed [1, 14, 15, 30, 85, 92, 93].…”

Section: Risk Factorsmentioning

confidence: 99%

“…Histological and molecular characteristics of initial tumor were also investigated. Astrocytic phenotype, high Ki67/Mib1 expression index [1, 29, 60, 85, 101, 102], and GFAP loss of expression either at initial diagnosis [10] or at recurrence [28, 29] were correlated with higher risk of LMS. Epithelioid GBM [26, 103, 104] and GBM with a neuronal component or primitive neuroectodermal tumor–like GBM [56, 74] disseminate more frequently to CSF.…”

Section: Risk Factorsmentioning

confidence: 99%

“…Some molecular alterations have been also suggested as risk factors of LMS [85]. Gain of 1p36 [105], PTEN mutation [102, 106], and PlK3CA mutations [107] seem to predispose to meningeal seeding [102, 105, 106].…”

Section: Risk Factorsmentioning

confidence: 99%

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Leptomeningeal Spread in Glioblastoma: Diagnostic and Therapeutic Challenges

et al. 2020

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Background Glioblastoma (GBM) is the most common and aggressive primary malignant brain tumor. Leptomeningeal spread (LMS) is a severe complication of GBM, raising diagnostic and therapeutic challenges in clinical routine. Methods We performed a review of the literature focused on LMS in GBM. MEDLINE and EMBASE databases were queried from 1989 to 2019 for articles describing diagnosis and therapeutic options in GBM LMS, as well as risk factors and pathogenic mechanisms. Results We retrieved 155 articles, including retrospective series, case reports, and early phase clinical trials, as well as preclinical studies. These articles confirmed that LMS in GBM remains (a) a diagnostic challenge with cytological proof of LMS obtained in only 35% of cases and (b) a therapeutic challenge with a median overall survival below 2 months with best supportive care alone. For patients faced with suggestive clinical symptoms, whole neuroaxis magnetic resonance imaging and cerebrospinal fluid analysis are both recommended. Liquid biopsies are under investigation and may help prompt a reliable diagnosis. Based on the literature, a multimodal and personalized therapeutic approach of LMS, including surgery, radiotherapy, systemic cytotoxic chemotherapy, and intrathecal chemotherapies, may provide benefits to selected patients. Interestingly, molecular targeted therapies appear promising in case of actionable molecular target and should be considered. Conclusion As the prognosis of glioblastoma is improving over time, LMS becomes a more common complication. Our review highlights the need for translational studies and clinical trials dedicated to this challenging condition in order to improve diagnostic and therapeutic strategies. Implications for Practice This review summarizes the diagnostic tools and applied treatments for leptomeningeal spread, a complication of glioblastoma, as well as their outcomes. The importance of exhaustive molecular testing for molecular targeted therapies is discussed. New diagnostic and therapeutic strategies are outlined, and the need for translational studies and clinical trials dedicated to this challenging condition is highlighted.

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Section: Clinical Presentationmentioning

confidence: 99%

Section: Risk Factorsmentioning

confidence: 99%

Section: Risk Factorsmentioning

confidence: 99%

Section: Risk Factorsmentioning

confidence: 99%

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Leptomeningeal Spread in Glioblastoma: Diagnostic and Therapeutic Challenges

et al. 2020

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“…The most common grade III tumor is anaplastic astrocytoma (AA) and grade IV tumor is glioblastoma multiforme (GBM). There is a lack of consensus on the appropriate treatment for PDLG; most treatment regimens mainly focus on chemoradiotherapy and palliative management [ 1 2 3 ]. PDLG is typically characterized by glial cell infiltration with or without specific evidence of a primary brain or spinal cord mass lesion.…”

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics of High-Grade Glioma with Primary Leptomeningeal Seeding at Initial Diagnosis in a Single Center Study

Kwon

Hwang

et al. 2020

Brain Tumor Res Treat

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Background High-grade glioma (HGG) with primary leptomeningeal seeding (PLS) at initial diagnosis is rare. The purpose of this study was to identify its clinical features and to describe the clinical treatment outcomes. Methods We retrospectively reviewed the medical records of patients with HGG (World Health Organization grade III or IV) at our institution between 2004 and 2019, and patients with PLS at the initial diagnosis were enrolled in the study. Clinical features, such as the location of leptomeningeal seeding, surgical methods, and degree of resection, were sorted based on electronic medical records also containing performance scale, and hematological and serological evaluations. Radiological findings and immunohistochemical categories were confirmed. Furthermore, we sought to determine whether controlling intracranial pressure (ICP) via early cerebrospinal fluid (CSF) diversion increases overall survival (OS) after the initial diagnosis. Results Of the 469 patients with HGG in our institution, less than 2% had PLS at the initial diagnosis. Most patients suffered from headache, diplopia, and dizziness. Pathological findings included 7 glioblastomas and 2 anaplastic astrocytomas. Seven of the 9 patients underwent CSF diversion. All patients were administered concurrent chemoradiotherapy (CCRT) with temozolomide, 89% of which started adjuvant temozolomide and 33% of which completed the six cycles of adjuvant temozolomide. The OS of patients with HGG and PLS was 8.7 months (range, 4-37), an extremely poor result compared to that of other studies. Also, the 1-year and 2-year OS rates were 44.4% and 16.7%, respectively. Conclusion Diagnosis and treatment of HGG with PLS are challenging. Aggressive control of ICP followed by early initiation of standard CCRT seems to be helpful in improving symptoms. However, despite aggressive treatment, the prognosis is poor. A multicenter trial and research may be necessary to create a standardized protocol for this disease.

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Glioblastoma multiforme with metastasis to lung, bone, and chest wall: a case report

杜国波

周倩

贺馨瑶

et al. 2020

Oncology and Translational Medicine

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Glioblastoma multiforme (GBM) is a common brain tumor that rarely metastasizes extra-cranially. We present the case of a 40-year-old male with left temporal GBM who underwent craniotomy followed by radiotherapy and chemotherapy. Postoperative MRI scans at different time intervals demonstrated a good response. Eleven months after the initial diagnosis, there were no clinical or radiological signs suggesting recurrence. However, the tumor showed metastasis simultaneously to the chest wall, lungs, and bone, despite 2 cycles of chemotherapy. The patient developed paraplegia 14 months after the initial diagnosis and died due to systemic failure 19 months after diagnosis. Extracranial metastasis of GBM is extremely rare. We present the unusual case of a patient with GBM who showed simultaneous metastasis to the lungs, bone, and chest wall. The prognosis of patients with extracranial metastasis of glioblastomas is very poor, regardless of chemoradiotherapy. Newer approaches, such as immunotherapy and anti-angiogenic therapy, need to be further studied.

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Extensive Leptomeningeal Intracranial and Spinal Metastases in a Patient with a Supratentorial Glioblastoma Multiforme, IDH-Wildtype

Cited by 10 publications

References 26 publications

Leptomeningeal Spread in Glioblastoma: Diagnostic and Therapeutic Challenges

Leptomeningeal Spread in Glioblastoma: Diagnostic and Therapeutic Challenges

Clinical Characteristics of High-Grade Glioma with Primary Leptomeningeal Seeding at Initial Diagnosis in a Single Center Study

Glioblastoma multiforme with metastasis to lung, bone, and chest wall: a case report

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