Cognitive functions are differentially represented in brain hemispheres. Aphasia is an “easy to recognize” symptom of diseases affecting the left side. In contrast, lesions in the right hemisphere cause subtle neuropsychological deficits such as neglect and anosognosia. We evaluated whether right-sided malignant brain tumors are on average larger at the time of first diagnosis as compared to left-sided tumors, and extrapolated the delay in diagnosing right-sided tumors compared to the left side.
All first-ever diagnosed glioblastoma (GBM) patients between 2005 and 2012 were identified using our hospital-based prospective research registry. Baseline data, information on initial clinical presentation and imaging findings (including tumor volume) were collected. Extrapolation of time since tumor initiation was based on an established gompertzian growth model.
We included 173 patients. Mean age of the study population was 58 ± 13 years. Tumors located in the right hemisphere (n = 96) were larger as compared to tumors located in the left hemisphere (n = 77) (median 36.4 mL [interquartile range 13.0–56.0; minimum 0.2, maximum 140.0] vs. 17.2 mL [7.7–45.1 mL; 0.4, 105.2]; p = 0.011). Right-sided tumors grew longer than left-sided tumors (378 ± 95 days vs. 341 ± 74 days; p = 0.006). Initial neuropsychological symptoms differed depending on the affected hemisphere.
Right-hemispheric symptoms appear to be less clinically conspicuous resulting in a delayed diagnosis of GBM, which might be improved by raising awareness for the corresponding neuropsychological deficits. Whether our findings have prognostic implications needs to be evaluated in future studies.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Gotts SJ, Jo HJ, Wallace GL, Saad ZS, Cox RW, Martin A (2013) Two distinct forms of functional lateralization in the human brain. Proc Natl Acad Sci USA 110:E3435–3444. https://doi.org/10.1073/pnas.1302581110
Foerch C, Misselwitz B, Sitzer M, Berger K, Steinmetz H, Neumann-Haefelin T, Arbeitsgruppe Schlaganfall H (2005) Difference in recognition of right and left hemispheric stroke. Lancet 366:392–393. https://doi.org/10.1016/S0140-6736(05)67024-9
Stensjoen AL, Berntsen EM, Jakola AS, Solheim O (2018) When did the glioblastoma start growing, and how much time can be gained from surgical resection? A model based on the pattern of glioblastoma growth in vivo. Clin Neurol Neurosurg 170:38–42. https://doi.org/10.1016/j.clineuro.2018.04.028
Thiepold AL, Luger S, Wagner M, Filmann N, Ronellenfitsch MW, Harter PN, Braczynski AK, Dutzmann S, Hattingen E, Steinbach JP, Senft C, Rieger J, Bahr O (2015) Perioperative cerebral ischemia promote infiltrative recurrence in glioblastoma. Oncotarget 6:14537–14544. https://doi.org/10.18632/oncotarget.3994
Sreenivasan SA, Madhugiri VS, Sasidharan GM, Kumar RV (2016) Measuring glioma volumes: A comparison of linear measurement based formulae with the manual image segmentation technique. J Cancer Res Ther 12:161–168. https://doi.org/10.4103/0973-1482.153999
Sanai N, Polley MY, McDermott MW, Parsa AT, Berger MS (2011) An extent of resection threshold for newly diagnosed glioblastomas. J Neurosurg 115:3–8. https://doi.org/10.3171/2011.2.JNS10998
Inskip PD, Tarone RE, Hatch EE, Wilcosky TC, Selker RG, Fine HA, Black PM, Loeffler JS, Shapiro WR, Linet MS (2003) Laterality of brain tumors. Neuroepidemiology 22:130–138
Tait MJ, Petrik V, Loosemore A, Bell BA, Papadopoulos MC (2007) Survival of patients with glioblastoma multiforme has not improved between 1993 and 2004: analysis of 625 cases. Br J Neurosurg 21:496–500. https://doi.org/10.1080/02688690701449251
Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, Belanger K, Brandes AA, Marosi C, Bogdahn U, Curschmann J, Janzer RC, Ludwin SK, Gorlia T, Allgeier A, Lacombe D, Cairncross JG, Eisenhauer E, Mirimanoff RO (2005) For the European Organisation for Research and Treatment of Cancer Brain Tumor and Radiotherapy Groups and the National Cancer Institute of Canada Clinical Trials Group. N Engl J Med 352:987–996. https://doi.org/10.1056/NEJMoa043330
Coluccia D, Roth T, Marbacher S, Fandino J (2018) Impact of laterality on surgical outcome of glioblastoma patients: a retrospective single-center study. World Neurosurg 114:e121–e128. https://doi.org/10.1016/j.wneu.2018.02.084
Lacroix M, Abi-Said D, Fourney DR, Gokaslan ZL, Shi W, DeMonte F, Lang FF, McCutcheon IE, Hassenbusch SJ, Holland E, Hess K, Michael C, Miller D, Sawaya R (2001) A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg 95:190–198. https://doi.org/10.3171/jns.2001.95.2.0190
Stummer W, Reulen HJ, Meinel T, Pichlmeier U, Schumacher W, Tonn JC, Rohde V, Oppel F, Turowski B, Woiciechowsky C, Franz K, Pietsch T, Group AL-GS (2008) Extent of resection and survival in glioblastoma multiforme: identification of and adjustment for bias. Neurosurgery 62:564–576. https://doi.org/10.1227/01.neu.0000317304.31579.17discussion 564–576
MM would like to thank the Luxembourg National Research Fond (FNR) for the support (FNR PEARL P16/BM/11192868 Grant).
The author(s) received no specific funding for this work.
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the local ethics committee (SNO-06-2016).
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Baumann, C., Tichy, J., Schaefer, J.H. et al. Delay in diagnosing patients with right-sided glioblastoma induced by hemispheric-specific clinical presentation. J Neurooncol 146, 63–69 (2020). https://doi.org/10.1007/s11060-019-03335-4
- Brain tumor