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George J. Dohrmann, Jacqueline R. Farwell, and John T. Flannery

G lioblastoma multiforme occurs less often in children than in adults. 8, 38 In large series of patients with glioblastomas, less than 3% occurred in children ( Table 1 ). Glioblastomas accounted for approximately 7% of all intracranial neoplasms of childhood ( Table 2 ). Because the number of glioblastoma patients younger than 20 years of age is so small, the natural history and survival of children with glioblastoma multiforme have not been well documented. TABLE 1 Incidence of glioblastoma multiforme in children reported in nine large series

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Richard A. Berkman, W. Craig Clark, Abha Saxena, James T. Robertson, Edward H. Oldfield, and Iqbal U. Ali

of cells is exposed to an endogenous or an exogenous carcinogenic stimulus. Ionizing irradiation and intrathecal chemotherapy, for example, induce solitary and multifocal glioblastomas multiforme in humans 13, 24 and oncogenic viruses induce multifocal gliomas in animals, 34 supporting the possibility of a polyclonal composition of glioblastomas multiforme. However, a polyclonal composition would be inconsistent with the recent findings of clonal alterations on chromosomes 10 and 17 in some glioblastomas multiforme. 8, 14, 20, 21 Therefore, to address the issue

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Satoshi Utsuki, Satoshi Tanaka, Hidehiro Oka, Kazuhisa Iwamoto, Takao Sagiuchi, and Kiyotaka Fujii

thank San Francisco Edit ( for their assistance in editing this manuscript. References 1 Anzil AP : Glioblastoma multiforme with extracranial metastases in the absence of previous craniotomy. Case report. J Neurosurg 33 : 88 – 94 , 1970 Anzil AP: Glioblastoma multiforme with extracranial metastases in the absence of previous craniotomy. Case report. J Neurosurg 33: 88–94, 1970 2 Beauchesne P , Soler C , Mosnier JF : Diffuse vertebral body metastasis from a glioblastoma multiforme

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Abhaya V. Kulkarni, Laurence E. Becker, Venita Jay, Derek C. Armstrong, and James M. Drake

A strocytomas of the cerebellum are relatively common tumors in children, and the vast majority are of benign histological composition. 2, 16 Glioblastomas multiforme (GBMs) of the cerebellum (World Health Organization [WHO] Grade 4 astrocytoma) are exceedingly rare in children, with only occasional isolated reports. 3–6, 10, 13–15, 17, 18 We present our experience at the Hospital for Sick Children, Toronto, Canada, involving four children with cerebellar GBMs. We performed a detailed clinical, pathological and radiological analysis to better characterize

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Yushi Ueno, Masaaki Yamamoto, Israel Vlodavsky, Iris Pecker, Kohichi Ohshima, and Takeo Fukushima

the steps involved in the invasive spread of GBM and the underlying molecular mechanisms. 43 Note that GBM rarely metastasizes to distant organs despite its locally invasive nature in the CNS. 12 In general, the molecular mechanisms for local invasion and distant metastasis of malignant tumor cells are believed to be the same. Glioblastomas multiforme increasingly express proteolytic enzymes, the urokinase-type plasminogen activator/plasmin system of serine proteases and MMPs, 41–43 and adhesion molecules that have been implicated in metastatic processes in the

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Cheng-Mei Shaw, S. Mark Sumi, Ellsworth C. Alvord Jr., Arthur J. Gerdes, Alexander Spence, and Robert G. Parker

cells have been shown to be more resistant to conventional photon irradiation than to high linear energy transfer (LET) radiation such as fast neutron, 21 a pilot study using a fast-neutron beam to irradiate the whole brain for treatment of glioblastoma multiforme was initiated at the University of Washington Hospital in 1973; 34 patients have been thus treated. With the doses employed in this initial study there was no improvement in the length or quality of survival of these patients, but the destructive effects of the neutron beam on the tumor have been so

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Sayed El-Gindi, Mamdouh Salama, Mokhtar El-Henawy, and Said Farag

W e are reporting two rare cases of glioblastoma multiforme that metastasized to the cervical lymph nodes. The diagnosis was made by lymph node biopsy. Case Reports Case 1 This 22-year-old man reported to the hospital on August 19, 1970, complaining of headaches, vomiting, blurring of vision, and diplopia of 3 weeks' duration. Neurological examination revealed left homonymous hemianopia, bilateral papilledema, paresis of the lateral recti oculis muscles more evident on the right side, and a left extensor plantar response. Examination of the other

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Ruth G. Ramsey and William N. Brand

R ecent advances in brain scanning, angiography, and neurosurgery have aided in the localization of intracranial neoplasms and justify re-examination of existing radiation techniques. In particular, the relative value of limited field versus whole brain irradiation when treating glioblastoma multiforme of the brain needs to be reassessed. We undertook this study to compare the results of these two techniques, taking into consideration the size of the area treated as well as the dose used for treatment. Clinical Material and Methods Random Study In

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Anita Mahajan, Ian E. McCutcheon, Dima Suki, Eric L. Chang, Samuel J. Hassenbusch, Jeffrey S. Weinberg, Almon Shiu, Moshe H. Maor, and Shiao Y. Woo

support the consideration of either surgery or SRS in selected patients with recurrent GBMs. References 1. Chamberlain MC , Tsao-Wei DD : Salvage chemotherapy with cyclophosphamide for recurrent, temozolomide-refractory glioblastoma multiforme. Cancer 100 : 1213 – 1220 , 2004 Chamberlain MC, Tsao-Wei DD: Salvage chemotherapy with cyclophosphamide for recurrent, temozolomide-refractory glioblastoma multiforme. Cancer 100: 1213–1220, 2004 2. Chao ST , Suh JT , Raja S , Lee SY , Barnett G

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Peter C. Burger, E. Ralph Heinz, Taichiro Shibata, and Paul Kleihues

A lthough the glioblastoma multiforme (GBM) is the most common glioma and the continued subject of intensive clinical and radiographic study, its topographic anatomy is poorly understood. This lack of information is especially acute in light of the increasing interest in local radio- and chemotherapies, the effective applications of which depend upon exact tumor localization. 5, 8, 9 Previous computerized tomography (CT) studies have shown that the typical enhancing rim of the untreated glioblastoma represents a markedly cellular neoplasm, but these studies