Prognostic significance of intracranial dissemination of glioblastoma multiforme in adults

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Object. The clinical outcome and treatment of adult patients with disseminated intracranial glioblastoma multiforme (GBM) is unclear. The objective in the present study was to assess the prognostic significance of disseminated intracranial GBM in adults at presentation and at the time of tumor progression.

Methods. Clinical data from 1491 patients older than 17 years and harboring a GBM that had been diagnosed between 1988 and 1998 at the University of California at San Francisco neurooncology clinic were retrospectively reviewed. Dissemination of the GBM (126 patients) was determined based on Gd-enhanced magnetic resonance images. Classification of dissemination was as follows: Type I, single lesion with subependymal or subarachnoid spread; Type II, multifocal lesions without subependymal or subarachnoid spread; and Type III, multifocal lesions with subependymal or subarachnoid spread. Subgroups of patients were compared using Kaplan—Meier curves that depicted survival probability.

The median postprogression survival (PPS), defined according to neuroimaging demonstrated dissemination, was 37 weeks for Type I (23 patients), 25 weeks for Type II (50 patients), and 10 weeks for Type III spread (19 patients). Patients with dissemination at first tumor progression (52 patients) overall had a shorter PPS than those in a control group with local progression, after adjusting for age, Karnofsky Performance Scale score, and time from tumor diagnosis to its progression (311 patients). When analyzed according to tumor dissemination type, PPS was significantly shorter in patients with Type II (33 patients, p < 0.01) and Type III spread (11 patients, p < 0.01) but not in those with Type I spread (eight patients, p = 0.18).

Conclusions. Apparently, the presence of intracranial tumor dissemination on initial diagnosis does not in itself preclude aggressive treatment if a patient is otherwise well. A single focus of GBM that later demonstrates Type I dissemination on progression does not have a worse prognosis than a lesion that exhibits only local recurrence.

Article Information

Address reprint requests to: Andrew T. Parsa, M.D., Ph.D., Department of Neurological Surgery, 505 Parnassus Avenue, San Francisco, California 94143. email: parsaa@neurosurg.ucsf.edu.

© AANS, except where prohibited by US copyright law.

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Figures

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    Three types of intracranial dissemination were defined based on their appearance on conventional T1-weighted MR images with contrast. Upper Left: Axial sections demonstrating subependymal or subarachnoid spread, that is, Type I dissemination. Right: Coronal image demonstrating multifocal lesions without subependymal or subarachnoid spread, or Type II dissemination. Lower: Multifocal lesions with subependymal or subarachnoid spread, or Type III spread.

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    Graph of survival curve for patients with tumor dissemination at diagnosis. This Kaplan—Meier survival curve depicts the survival probability in all 17 patients with dissemination at the time of initial diagnosis.

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    Graph of postdissemination survival in patients stratified by type of dissemination. This Kaplan—Meier survival curve depicts the survival probability in patients following dissemination, as stratified by spread type. — - — represents Type I spread; dashed line, Type II; and — —, Type III.

  • View in gallery

    Graphs depicting survival in patients with dissemination on first progression. Upper: This Kaplan—Meier survival curve depicts survival probability in patients with dissemination at first progression as compared with appropriately matched controls. Dashed line represents patients with dissemination; solid line, controls. Lower: This Kaplan—Meier survival curve depicts survival probability in patients after dissemination on first tumor progression, as stratified by type. — - — represents Type I; dashed line, Type II; and — —, Type III.

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