Malignant seeding of the biopsy needle tract outside of the radiation therapy field in a patient with Glioblastoma

Abstract

A 44-year-old male initially presented with a right thalamic brain tumor that was confirmed with stereotactic biopsy to be glioblastoma (GBM). The patient was treated with radiotherapy and temozolomide for 6 weeks. At 1 month after completing chemoradiation therapy, the patient underwent follow-up imaging that revealed the primary lesion had mildly responded to chemoradiation, but a secondary lesion had developed along the biopsy needle tract. This secondary lesion was outside of the field of radiation therapy for the primary tumor and concluded to be intracranial spread of GBM along the biopsy tract. The patient’s final imaging 4 months after initial diagnosis revealed the primary and secondary lesions had enlarged. Subsequently, the patient clinically deteriorated and died 7 months after initial diagnosis.

Commentary: Risk of Tract Seeding Following Laser Interstitial Thermal Therapy for Brain Tumors

“…6 Reports in the literature of biopsy tract seeding have spanned pathologies ranging from not only brain metastases and gliomas but intracranial pathologies such as pineoblastoma, as well as needle biopsies of tumors in the lung, breast, kidney, prostate, gastrointestinal tract, and liver. 7 While beyond the scope of this commentary, such studies have discussed the potential of extending radiation fields outside the primary tumor when seeding is a concern. Regardless, this study offers critical data in the larger discussion of seeding, and further studies including data from more hospitals and patients may help clarify the true rate of tract seeding and thus inform a path forward in altering surgical technique to reduce this risk.…”