Gliomas Infiltrating the Corpus Callosum: A Systematic Review of the Literature

Abstract

Background: Gliomas infiltrating the corpus callosum (G-I-CC) majorly impact patient quality-of-life, but maximally safe tumor resection is challenging. We systematically reviewed the literature on G-I-CC. Methods: PubMed, EMBASE, Scopus, Web of Science, and Cochrane were searched following the PRISMA guidelines to include studies of patients with G-I-CC. Clinicopathological features, treatments, and outcomes were analyzed. Results: We included 52 studies comprising 683 patients. Most patients experienced headache (33%), cognitive decline (18.7%), and seizures (17.7%). Tumors mostly infiltrated the corpus callosum genu (44.2%) with bilateral extension (85.4%) into frontal (68.3%) or parietal (8.9%) lobes. Most G-I-CC were glioblastomas (84.5%) with IDH-wildtype (84.9%) and unmethylated MGMT promoter (53.5%). Resection (76.7%) was preferred over biopsy (23.3%), mostly gross-total (33.8%) and subtotal (32.5%). The tumor-infiltrated corpus callosum was resected in 57.8% of cases. Radiation was delivered in 65.8% of patients and temozolomide in 68.3%. Median follow-up was 12 months (range, 0.1–116). In total, 142 patients (31.8%) experienced post-surgical complications, including transient supplementary motor area syndrome (5.1%) and persistent motor deficits (4.3%) or abulia (2.5%). Post-treatment symptom improvement was reported in 42.9% of patients. No differences in rates of complications (p = 0.231) and symptom improvement (p = 0.375) were found in cases with resected versus preserved corpus callosum. Recurrences occurred in 40.9% of cases, with median progression-free survival of 9 months (0.1–72). Median overall survival was 10.7 months (range, 0.1–116), significantly longer in low-grade tumors (p = 0.013) and after resection (p < 0.001), especially gross-total (p = 0.041) in patients with high-grade tumors. Conclusions: G-I-CC show clinicopathological patterns comparable to other more frequent gliomas. Maximally safe resection significantly improves survival with low rates of persistent complications.

Perspective Chapter: Glioblastoma of the Corpus Callosum

“…Glioblastoma of the corpus callosum is characterised by a rapidly progressive deteriorating clinical course [11]. Progressive tumour growth in CC causes mass effect and white matter network connectivity changes (due to oedema or direct infiltration) [12]. Because of its location corpus callosum, glioblastomas involve the highly eloquent area of the brain, leading to impaired higher mental function, severe neurological deterioration and features of raised intracranial pressure (headache, vomiting and altered sensorium) [11,13].…”

“…Evidence suggests that preoperative KPS score, adjuvant radio chemotherapy and extent of surgical resection (EoR) have impact on survival besides patient's age. In a systematic review done by Palmisciano et al [12], they say that resection of glioma infiltrating the corpus callosum has no significant changes in the post operative complications. Gross total resection of the tumour increases overall survival.…”

“…However, because of its unique location and spread, in comparison with other GBMs, the conservative resection of corpus callosum is possible, thus reducing the chances of overall survival [9][10][11][12]. Temozolomide alone or in combination has been shown as a safer alternative in elderly population [26,28,42,43].…”

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

“…This distant recurrence may be attributed to leptomeningeal dissemination (LMD) through the cerebrospinal fluid (CSF) and infiltration along the white matter tracts [ 5 , 6 , 32 ]. Examples of infiltration along the white matter tracts include extension to the contralateral hemisphere via the corpus callosum [ 27 ], which is called “butterfly glioblastoma,” extension to the contralateral cerebrum via the anterior commissure [ 19 ], and extension to the brainstem via the corticopontine tract [ 5 ].…”

Prognostic Impact of Low-Level p53 Expression on Brain Astrocytomas Immunopositive for Epidermal Growth Factor Receptor

“…Although surgical resection of brain astrocytomas provides timely relief of the mass effect, high-grade astrocytomas unavoidably recur even after concurrent chemoradiotherapy. With advances in targeted therapy, oncolytic viral therapy, and immunotherapy, tumor resection with adjuvant chemotherapy and radiation is the standard therapy for gliomas [ 2 , 3 ]. The currently adopted histological grading for tumors is not predictive of the treatment response or patient outcome.…”