Leptomeningeal disease in glioblastoma: endgame or opportunity?

Akmal, Sarfraz; Ginalis, Elizabeth E.; Patel, Nitesh V; Aiken, Robert; Dicpinigaitis, Alis J.; Hanft, Simon

doi:10.1007/s11060-021-03864-x

Cited by 16 publications

(21 citation statements)

References 44 publications

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“…Fourth, the risk of nodular leptomeningeal disease for brain metastasis patients appears lower when SRS is administered preoperatively [ 42 ]. The risk of leptomeningeal disease for GBM patients is approximately 4% and frequently represents a dismal development for GBM patients [ 99 , 100 ].…”

Section: Stereotactic Radiosurgerymentioning

confidence: 99%

Preoperative Stereotactic Radiosurgery for Glioblastoma

Lehrer

Ruiz‐Garcia

Nehlsen

et al. 2022

Biology

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Glioblastoma is a devastating primary brain tumor with a median overall survival of approximately 15 months despite the use of optimal modern therapy. While GBM has been studied for decades, modern therapies have allowed for a reduction in treatment-related toxicities, while the prognosis has largely been unchanged. Adjuvant stereotactic radiosurgery (SRS) was previously studied in GBM; however, the results were disappointing. SRS is a highly conformal radiation technique that permits the delivery of high doses of ionizing radiation in 1–5 sessions while largely sparing surrounding healthy tissues. Furthermore, studies have shown that the delivery of ablative doses of ionizing radiation within the central nervous system is associated with enhanced anti-tumor immunity. While SRS is commonly used in the definitive and adjuvant settings for other CNS malignancies, its role in the preoperative setting has become a topic of great interest due to the potential for reduced treatment volumes due to the treatment of an intact tumor, and a lower risk of nodular leptomeningeal disease and radiation necrosis. While early reports of SRS in the adjuvant setting for glioblastoma were disappointing, its role in the preoperative setting and its impact on the anti-tumor adaptive immune response is largely unknown. In this review, we provide an overview of GBM, discuss the potential role of preoperative SRS, and discuss the possible immunogenic effects of this therapy.

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Section: Stereotactic Radiosurgerymentioning

confidence: 99%

Preoperative Stereotactic Radiosurgery for Glioblastoma

Lehrer

Ruiz‐Garcia

Nehlsen

et al. 2022

Biology

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“…Leptomeningeal dissemination (LMD), also called leptomeningeal metastasis,is a severe complication of GBM and is considered an end-stage disease [3].The median overall survival (OS) of patients with GBM with LMDis2.1-5.7 months [4][5][6][7][8]with various types of chemotherapy or radiation. Since long survival [9]is suspected as one of the risk factors for LMD in patients with GBM,the improvement of prognosis leads LMD to be a more common and indispensable clinical proposition [10].…”

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics and Prognosis of Patients with Glioblastoma with Infratentorial Leptomeningeal Dissemination

Kawauchi

Ohno

Honda‐Kitahara

et al. 2022

Preprint

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Objective: Leptomeningeal dissemination (LMD) is a severe complication of glioblastoma (GBM) and has become a more common and indispensable clinical proposition with improved patient prognosis. Although infratentorial leptomeningeal dissemination (ITD) of GBM is rare, it is clinically significant as it may largely influence patient prognosis. Here, we investigated the clinical characteristics and prognosis of patients with ITD.Methods: Data of patients with newly diagnosed isocitrate dehydrogenase (IDH)-wildtype GBM treated at our institution between October 2008 and December 2018 were reviewed. ITD was defined as the dissemination of GBM, which first emerged as a supratentorial tumor, and later disseminated in the infratentorial region as the first recurrent site.Results: Of 160 patients with newly diagnosed IDH-wildtype GBM, seven (4.4%) were classified as having ITD. ITD lesions were in the fourth ventricle in two patients, extra-cerebellum or extra-brainstem in two, and intra-cerebellum in three. The primary symptoms of ITD were gait disturbance (85.7%, n=6), nausea and vomiting (28.6%, n=2), cerebellar mutism (14.3%, n=1), and none (14.3%, n=1). In four cases (57.1%), symptoms were confirmed before ITD discovery.The median progression-free survival (PFS) and overall survival of the patients were 12.2 and 19.7 months, respectively. Radiotherapy was performed in five patients, and all the patients received chemotherapy. The PFS and overall survival rates from ITD diagnosis were 2.9 and 7.1 months, respectively. Patients with favorable prognoses were younger and had higher Karnofsky performance status (KPS) scores.Conclusions: Radiotherapy or molecular-targeted therapy may be effective in some cases of ITD and may contribute to extending survival. Carefully checking the infratentorial region of patients with GBM during follow-up and rapidly treating ITD before their KPS score starts declining are crucial.

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“…The median overall survival (OS) of patients with GBM with LMD is 2.1-5.7 months [4][5][6][7][8] with various types of chemotherapy or radiation. Since long survival [9] is suspected as one of the risk factors for LMD in patients with GBM, the improvement of prognosis leads LMD to be a more common and indispensable clinical proposition [10].…”

Section: Introductionmentioning

confidence: 99%

Clinical characteristics and prognosis of patients with glioblastoma with infratentorial leptomeningeal dissemination

Kawauchi

Ohno

Honda‐Kitahara

et al. 2022

Preprint

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Objective Leptomeningeal dissemination (LMD) is a severe complication of glioblastoma (GBM) and has become a more common and indispensable clinical proposition with improved patient prognosis. Although infratentorial leptomeningeal dissemination (ITD) of GBM is rare, it is clinically significant as it may largely influence patient prognosis. Here, we investigated the clinical characteristics and prognosis of patients with ITD. Methods Data of patients with newly diagnosed isocitrate dehydrogenase (IDH)-wildtype GBM treated at our institution between October 2008 and December 2018 were reviewed. ITD was defined as the dissemination of GBM, which first emerged as a supratentorial tumor, and later disseminated in the infratentorial region as the first recurrent site. Results Of 160 patients with newly diagnosed IDH-wildtype GBM, seven (4.4%) were classified as having ITD. ITD lesions were in the fourth ventricle in two patients, extra-cerebellum or extra-brainstem in two, and intra-cerebellum in three. The primary symptoms of ITD were gait disturbance (85.7%, n = 6), nausea and vomiting (28.6%, n = 2), cerebellar mutism (14.3%, n = 1), and none (14.3%, n = 1). In four cases (57.1%), symptoms were confirmed before ITD discovery. The median progression-free survival (PFS) and overall survival of the patients were 12.2 and 19.7 months, respectively. Radiotherapy was performed in five patients, and all the patients received chemotherapy. The PFS and overall survival rates from ITD diagnosis were 2.9 and 7.1 months, respectively. Patients with favorable prognoses were younger and had higher Karnofsky performance status (KPS) scores. Conclusions Radiotherapy or molecular-targeted therapy may be effective in some cases of ITD and may contribute to extending survival. Carefully checking the infratentorial region of patients with GBM during follow-up and rapidly treating ITD before their KPS score starts declining are crucial.

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Leptomeningeal disease in glioblastoma: endgame or opportunity?

Cited by 16 publications

References 44 publications

Preoperative Stereotactic Radiosurgery for Glioblastoma

Preoperative Stereotactic Radiosurgery for Glioblastoma

Clinical Characteristics and Prognosis of Patients with Glioblastoma with Infratentorial Leptomeningeal Dissemination

Clinical characteristics and prognosis of patients with glioblastoma with infratentorial leptomeningeal dissemination

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