The natural history of extracranial metastasis from glioblastoma multiforme

Abstract

Extracranial metastasis is a unique but rare manifestation of glioblastoma multiforme. It is thought to arise from glioblastoma cells disseminated into the blood stream. We undertook a comprehensive analysis of 88 cases of extracranial glioblastoma (5 were gliosarcomas) published between 1928 and 2009. Cases included in the analysis were primary or secondary glioblastomas that subsequently invaded organs outside the brain or spinal cord. The median age was 38 years and the median overall survival time was 10.5 months (range 0.0-60.0 months). The median time from symptom onset to diagnosis of primary glioblastoma was 2.5 months, from diagnosis to detection of extracranial metastasis was 8.5 months, and from metastasis to death was 1.5 months. From 1940 to 2009, there has been progressive lengthening of the interval from detection of extracranial metastasis to death, at a rate of 0.7 months per decade (95% confidence interval 0.5-1.0 month). Use of magnetic resonance imaging correlates with an increase in overall survival but not age, gender, or site of primary glioblastoma. Patients treated with surgery + radiation + chemotherapy + cerebrospinal fluid shunting had the longest average survival interval from metastasis to death when compared to those treated with surgery alone, radiation alone, surgery + radiation, and surgery + radiation + chemotherapy. Lung metastasis is a prognostic factor of extremely poor outcomes. We conclude that patients with glioblastoma extracranial metastasis have poor prognosis, but there has been a progressive lengthening of survival in each successive decade from 1940 to 2000.

Extracranial metastasis of gliobastoma: Three illustrative cases and current review of the molecular pathology and management strategies

“…A recently published meta-analysis of 88 cases of extracranial GBM between 1928 and 2009 demonstrated that the prognosis is particularly poor in this subset of patients, with a median survival from metastasis to death of 1.5 months; however, there has been a progressive prolongation of this interval of 0.7 months per decade between 1940 and 2000 (9). Patients treated with surgery, radiation, chemotherapy and cerebrospinal fluid (CSF) shunting exhibit the longest average survival interval from metastasis to death.…”

Extracranial oral cavity metastasis from glioblastoma multiforme: A case report

“…Younger patients exhibit an increased risk of extraneural involvement due to prolonged survival (15,17). The most common sites of extracranial metastases from glioblastoma are the lungs, bone (bone marrow), lymph nodes and soft tissues (14). This is the second report of an extracranial metastasis with a retromaxillary localization, exhibiting rapid growth and completely filling the buccal cavity.…”

“…The natural history of glioblastomas that metastasize to organs outside the central nervous system is largely unknown. Between 1928 and 2009, 88 cases of extracranial metastasis from glioblastoma (n=83) and gliosarcoma (n=5) have been published, reported and analyzed by Lun et al (14). In 2015, Pietschmann et al reviewed existing data and performed a new meta-analysis with 150 cases (15).…”

Reply to Dr. Beauchesne

“…We thank Dr. Beauchesne's comment [1] regarding our work on extracranial glioblastoma [2] and, hereby, address the issues raised by him. First, the following search terms were used in the selection of published literature: (i) extracranial glioblastoma, and (ii) extracranial metastasis glioblastoma.…”