Abstract
Glioblastoma multiforme (GBM) is the most common malignant primary brain tumor in adults. Compared with other malignancies, remote metastases in GBM are rare. However, multicentric spreading within the central nervous system is common and also metastases to the spinal cord have been reported. Some of these drop metastases may also lead to malignant spinal cord compression (MSCC). We retrospectively identified nine patients from 2001 to 2010 and performed data analysis according to a standardized clinical protocol. We also provide a review of the literature on this rare condition. MSCC from cerebral GBM is rare and is found in approximately 1 % of GBM patients. Median age of 54 years in this case series is comparable with that of GBM patients without MSCC. Treatment regimens for cerebral GBM and overall survival was similar to those for patients without MSCC. Spinal metastasis seems to occur in the advanced state of the disease, and the outcome subsequently is extremely poor. All patients presented with multicentric radiological features of GBM on cerebral MRI when MSCC was diagnosed. Subependymal enhancement is another common radiological finding in GBM patients with spinal drop metastases. Steroids and focal radiotherapy were used to treat all patients, with little clinical benefit. This study is the largest case series of MSCC from cerebral GBM. Multicentric cerebral distribution and subependymal enhancement of GBM are observed on cerebral MRI at the time of MSCC. On the basis of our results, no specific treatment recommendations for MSCC in GBM patients can be given. However, accurate diagnosis of MSCC in GBM patients with spinal signs and symptoms can lead to adequate management of symptoms and improvement of quality of life in terms of best palliative care.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
.References
Schiff D, Wen P (2003) Cancer neurology in clinical practice. Humana Press Inc., Germany
Scoccianti S, Detti B, Meattini I, Iannalfi A, Sardaro A, Leonulli BG, Martinelli F, Bordi L, Pellicanò G, Biti G (2008) Symptomatic leptomeningeal and intramedullary metastases from intracranial glioblastoma multiforme: a case report. Tumori 94:877–881
Stark AM, Nabavi A, Mehdorn HM, Blömer U (2005) Glioblastoma multiforme-report of 267 cases treated at a single institution. Surg Neurol 63:162–169
Schwaninger M, Patt S, Henningsen P, Schmidt D (1992) Spinal canal metastases: a late complication of glioblastoma. J Neurooncol 12:93–98
Lun M, Lok E, Gautam S, Wu E, Wong ET (2011) The natural history of extracranial metastasis from glioblastoma multiforme. J Neurooncol 105:261–273
Hamilton MG, Tranmer BI, Hagen NA (1993) Supratentorial glioblastoma with spinal cord intramedullary metastasis. Can J Neurol Sci 20:65–68
Saito R, Kumabe T, Jokura H, Shirane R, Yoshimoto T (2003) Symptomatic spinal dissemination of malignant astrocytoma. J Neurooncol 61:227–235
Karaca M, Andrieu MN, Hicsonmez A, Guney Y, Kurtman C (2006) Cases of glioblastoma multiforme metastasizing to spinal cord. Neurol India 54:428–430
Fakhrai N, Czech T, Diekmann K, Fazeny-Dörner B, Birner P, Hainfellner JA, Prayer D, Marosi C (2004) Glioblastoma with spinal seeding. Strahlenther Onkol 180:455–457
Alatakis S, Malham GM, Thien C (2001) Spinal leptomeningeal metastasis from cerebral glioblastoma multiforme presenting with radicular pain: case report and literature review. Surg Neurol 56:33–37
Birbilis TA, Matis GK, Eleftheriadis SG, Theodoropoulou EN, Sivridis E (2010) Spinal metastasis of glioblastoma multiforme: an uncommon suspect? Spine (Phila Pa 1976) 35:264–269
Shah A, Redhu R, Nadkarni T, Goel A (2010) Supratentorial glioblastoma multiforme with spinal metastases. J Craniovertebral Junction Spine 1:126–129
Materlik B, Steidle-Katic U, Wauschkuhn B, Feyerabend T, Richter E (1998) Spinal metastases of malignant gliomas. Strahlenther Onkol 174:478–481
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) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. European organisation for research and treatment of cancer brain tumor and radiotherapy groups; national cancer institute of Canada clinical trials group. N Engl J Med 352:987–996
Macdonald DR, Cascino TL, Schold SC Jr, Cairncross JG (1990) Response criteria for phase II studies of supratentorial malignant glioma. J Clin Oncol 8:1277–1280
Aghakhani N, Roux FX, Fallet-Bianco C, Devaux B (1995) Secondary intraspinal localizations of glioblastoma. Apropos of a case. Neurochirurgie 41:363–366
Central brain tumor registry of the United States (2011). http://cbtrus.org/2007-2008/2007-20081.html. Accessed 10 September 2011
Chamberlain MC (2011) Radiographic patterns of relapse in glioblastoma. J Neurooncol 101:319–323
Hefti M, von Campe G, Schneider C, Roelcke U, Landolt H (2010) Multicentric tumor manifestations of high grade gliomas: independent proliferation or hallmark of extensive disease? Cen Eur Neurosurg 71:20–25
Davis PC, Friedman NC, Fry SM, Malko JA, Hoffmann JC Jr, Braun IF (1987) Leptomeningeal metastasis: MR imaging. Radiology 163:449–454
Acknowledgments
The authors are grateful for the support of the radiological department of the University Hospital of Vienna.
Conflicts of interest
The authors declare they have no conflicts of interest
Author information
Authors and Affiliations
Corresponding author
Additional information
The abstract has been submitted for poster presentation at the EANO 2012.
Rights and permissions
About this article
Cite this article
Tinchon, A., Oberndorfer, S., Marosi, C. et al. Malignant spinal cord compression in cerebral glioblastoma multiforme: a multicenter case series and review of the literature. J Neurooncol 110, 221–226 (2012). https://doi.org/10.1007/s11060-012-0955-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11060-012-0955-8