Abstract
Object: Symptomatic spinal dissemination of malignant astrocytoma is rarely found except at autopsy. This study evaluated the clinical incidence and characteristics of spinal dissemination and the effect on outcome.
Patients and methods: Patients treated for primary malignant astrocytoma, including 33 with anaplastic astrocytoma and 35 with glioblastoma, at our department between 1997 and 1999 were followed up until April 30, 2001. Head magnetic resonance (MR) imaging of all patients was obtained every 2–3 months. Signs and symptoms of leptomeningeal spread were checked at monthly outpatient examinations. Spinal MR imaging was performed if any symptoms indicating spinal dissemination were found.
Results: Median survival times of patients with anaplastic astrocytoma and glioblastoma were 40.5 and 16.0 months, respectively. Seventeen patients (25%) developed intracranial dissemination and 15 of these died. Six patients (8.8%), one with anaplastic astrocytoma and five with glioblastoma, developed spinal dissemination. All patients with spinal dissemination also had intracranial dissemination. Five of the six patients died, despite systemic radiochemotherapy in four patients. All patients died of extensive whole brain and spinal dissemination or nodular mass enlargement at the upper cervical cord, not of local massive tumor progression.
Conclusions: Symptomatic spinal dissemination of malignant astrocytoma is not so rare, and is the cause of death. The relatively high incidence of symptomatic leptomeningeal dissemination must be considered in the treatment of malignant astrocytomas.
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References
Bryan P: CSF seeding of intra-cranial tumors: a study of 96 cases. Clin Radiol 25: 355–360, 1974
Carins H, Russell DS: Intracranial and spinal metastases in gliomas of the brain. Brain 54: 403–420, 1931
Moore MT, Eisinger G: Extra primary seeding of glioblastoma multiforme in the subarachnoid space and ependyma. Neurology 13: 855–865, 1963
Polmeter FE, Kernohan JW: Meningeal gliomatosis. Arch Neurol Psychiatry 57: 593–616, 1947
Salazar OM, Rubin P: The spread of glioblastoma multiforme as a determining factor in the radiation treated volume. Int J Radiat Oncol Biol Phys 1: 627–637, 1976
Erlich SS, Davis RL: Spinal subarachnoid metastasis from primary intracranial glioblastoma multiforme. Cancer 42: 2854–2864, 1978
Yung WA, Horten BC, Shapiro WR: Meningeal gliomatosis: a review of 12 cases. Ann Neurol 8: 605–608, 1980
Vertosick FT Jr, Selker RG: Brain stem and spinal metastases of supratentorial glioblastoma multiforme: a clinical series. Neurosurgery 27: 516–522, 1990
Kleihues P, Cavenee WK: Astrocytic tumours. In: Kleihues P, Cavenee WK (eds) Pathology and Genetics of Tumours of the Nervous System. IARC Press, Lyon, 2000, pp 9–54
Onda K, Tanaka R, Takahashi H, Takeda N, Ikuta F: Symptomatic cerebrospinal fluid dissemination of cerebral glioblastoma. Neuroradiology 32: 146–150, 1990
Buhl R, Barth H, Hugo H-H, Hutzelmann A, Mehdorn HM: Spinal drop metastases in recurrent glioblastoma multiforme. Acta Neurochir (Wien) 140: 1001–1005, 1998
Chesnut RM, Abitbol JJ, Chamberlain M, Marshall LF: Vertebral collapse with quadraparesis due to metastatic glioblastoma multiforme: case report and review of the literature. J Neuro-Oncol 16: 135–140, 1993
Hamilton MG, Tranmer BI, Hagen NA: Supratentorial glioblastoma with spinal cord intramedullary metastasis. Can J Neurol Sci 20: 65–68, 1993
Schwaninger M, Patt S, Henningsen P, Schmidt D: Spinal canal metastases: a late complication of glioblastoma. J Neuro-Oncol 12: 93–98, 1992
Grabb PA, Albright AL, Pang D: Dissemination of supratentorial malignant gliomas via the cerebrospinal fluid in children. Neurosurgery 30: 64–71, 1992
Elliott JP, Keles GE, Waite M, Temkin N, Berger MS: Ventricular entry during resection of malignant gliomas: effect on intracranial cerebrospinal fluid tumor dissemination. J Neurosurg 80: 834–839, 1994
Arita N, Taneda M, Hayakawa T: Leptomeningeal dissemination of malignant gliomas. Incidence, diagnosis and outcome. Acta Neurochir (Wien) 126: 84–92, 1994
Awad I, Bay JW, Rogers L: Leptomeningeal metastasis from supratentorial malignant gliomas. Neurosurgery 19: 247–251, 1986
Kyritsis AP, Levin VA, Yung WK, Leeds NE: Imaging patterns of multifocal gliomas. Eur J Radiol 16: 163–170, 1993
Minami T, Kai T, Hirabaru C, I shii E, Ueda K, Egami H, Takeshita I: A case of cerebral glioblastoma with extensive cerebrospinal fluid dissemination: diagnostic value of immunohistochemical examination and MR imaging. Childs Nerv Syst 9: 478–480, 1993
Lee Y-Y, T ien RD, Bruner JM, De Pena CA, Van Tassel P: Loculated intracranial leptomeningeal metastases: CT and MR characteristics. AJNR Am J Neuroradiol 10: 1171–1179, 1989
Kochi M, Kuratsu J, Mihara Y, Takaki S, Seto H, Uemura S, Ushio Y: Ventriculolumbar perfusion of 3-((4-amino-2-methyl-5-pyrimidynyl)methyl)-1-(2-chloroethyl)-1-nitrosourea hydrochloride. Neurosurgery 33: 817–823, 1993
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Saito, R., Kumabe, T., Jokura, H. et al. Symptomatic Spinal Dissemination of Malignant Astrocytoma. J Neurooncol 61, 227–235 (2003). https://doi.org/10.1023/A:1022536828345
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DOI: https://doi.org/10.1023/A:1022536828345