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Prognostic significance of intracranial dissemination of
glioblastoma multiforme in adults
Parsa AT, Wachhorst S, Lamborn KR, Prados MD, McDermott MW, Berger MS,
Chang SM
Department of Neurological Surgery, School of Medicine, University of
California at San Francisco, California 94143, USA.
parsaa@neurosurg.ucsf.edu
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, Kamofsky 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).
Conclusion.
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.
PMID: 15871503 [PubMed - in process]
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