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Anatomic features of glioblastoma and their potential impact on survival

Acta Neurochirurgica volume 157, pages 179–186 (2015)Cite this article

Abstract

Background

Many reports on glioblastoma multiforme discuss the prognostic impact of anatomical features such as cysts, necrotic changes, extent of edema or subependymal spread of tumor cells. In the present study, we examined different growth patterns and their possible relations to patient survival.

Methods

To analyze whether anatomical characteristics are related to prognosis, we reviewed the prospectively collected pre- and postoperative MRIs of 83 patients in the 5-ALA study, provided by the 5-ALA Glioma Study Group. Following a standardized analytic work flow, the tumor volume and site, presence of necrosis or cysts, and perifocal edema were assessed preoperatively. In the same way, postoperative MRI and the MRI at first recurrence were analyzed. In addition, survival time of the patients was documented.

Results

Median survival time of all 83 patients was 15.1 months (range 1.5 to 70.1, mean 18). The site or volume of glioblastoma, as well as the presence of intratumoral necrosis or cysts, did not exert a significant effect on survival time; 96.4 % of recurrences occurred within the former resection margin. Tumors with initial contact with the subependymal zone had multifocal or ventricular recurrences significantly more often. In patients with residual tumor on early postoperative MRI, the follow-up images displayed enlargement of the remnants in 91.9 % of these cases.

Conclusions

A merely anatomical analysis of the glioblastoma growth pattern cannot reliably provide prognostic information. The occurrence of most recurrences next to the resection margin and the high percentage of growing residual tumors underline the importance of complete resections.

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Abbreviations

ctx+:

Tumor tissue is present in the cerebral cortex

ctx-:

Tumor tissue is absent in the cerebral cortex

GBM:

Glioblastoma multiforme

n.a.:

Not applicable

n.r.:

Not reported

svz+:

Tumor tissue is present in the subventricular zone

svz-:

Tumor tissue is absent in the subventricular zone

T2w-HSC:

T2-weighted hyperintense signal change

p.s.:

Present study

Parts of this article were published as an oral presentation at the meeting of the Neurooncologic Group of the German Society of Neurosurgery (Jahrestagung der Sektion Neuroonkologie der DGNC):

Bonn 2009

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Conflicts of interest

None.

Author information

Affiliations

  1. Department of Neurosurgery, Justus Liebig University, Giessen, Germany

    U. Nestler & K. Lutz

  2. medac GmbH, Wedel, Germany

    U. Pichlmeier

  3. Department of Neurosurgery, University Clinic, Münster, Germany

    W. Stummer

  4. Department of Neurosurgery, Johann Wolfgang Goethe University, Frankfurt, Germany

    K. Franz

  5. Department of Neurosurgery, Ludwig Maximilian University, Munich, Germany

    H-J Reulen

  6. Department of Neuroradiology, Johann Wolfgang Goethe University, Frankfurt, Germany

    A. Bink

  7. Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland

    A. Bink

  8. Department of Neurosurgery, University Clinic Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany

    U. Nestler

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  1. U. Nestler
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  2. K. Lutz
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  3. U. Pichlmeier
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  4. W. Stummer
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  5. K. Franz
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  6. H-J Reulen
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  7. A. Bink
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Consortia

on behalf of the 5-ALA Glioma Study Group

Corresponding author

Correspondence to U. Nestler.

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Nestler, U., Lutz, K., Pichlmeier, U. et al. Anatomic features of glioblastoma and their potential impact on survival. Acta Neurochir 157, 179–186 (2015). https://doi.org/10.1007/s00701-014-2271-x

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  • DOI: https://doi.org/10.1007/s00701-014-2271-x

Keywords

  • 5-ALA Study Group
  • Cyst
  • Glioblastoma
  • Necrosis
  • Prognosis