gms | German Medical Science

63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

13. - 16. Juni 2012, Leipzig

Long-term survival in a patient with intramedullary glioblastoma in the thoracic region

Meeting Abstract

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  • K. Franz - Neurochirurgische Klinik, Johann-Wolfgang-Goethe-Universität, Frankfurt am Main
  • E. Hattingen - Institut für Neuroradiologie, Johann-Wolfgang-Goethe-Universität, Frankfurt am Main
  • V. Seifert - Neurochirurgische Klinik, Johann-Wolfgang-Goethe-Universität, Frankfurt am Main

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocP 076

DOI: 10.3205/12dgnc463, URN: urn:nbn:de:0183-12dgnc4632

Veröffentlicht: 4. Juni 2012

© 2012 Franz et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Spinal intramedullary glioblastoma (GBM) is a rare tumor with a very poor prognosis. Among the published cases mean survival period 19 months (3 to 36). We report the course of the disease in a patient with thoracic GBM from first symptoms to death from July 2006 until January 2011.

Methods: A 39-year-old woman presented with dysaesthesia of the right lower limb in September 2006. There was neither motor dysfunction nor signs of bowl or bladder dysfunction. MRI of the spine showed an intramedullary contrast enhancing tumor at the level of the fourth thoracic vertebrae. A cerebral MRI was normal. A biopsy revealed a GBM. A slight aggravation of the sensory deficits and a spinal ataxia were regressing under physiotherapy. Treatment was performed according to cerebral GBM’s.

Results: After radiochemotherapy (54 Gy Th 2 to 5 and temozolomide (TMZ) 75 mg/m2) paraparesis occurred and was regressing through intensive rehabilitation. Simultaneously, TMZ was continued for 6 adjuvant cycles until December 07. MRI showed a reduction of contrast enhancing tumor. In January 09 paraparesis aggravated and MRI showed progressive tumor. Despite a rechallenge with TMZ in an intensified manner (7/14) neurological aggravation went on and MRI showed tumor progression. Treatment was changed to bevacizumab in April 09. After 6 infusions a slight movement of the right foot reappeared but this amelioration did not go further. MRI showed a regression of contrast enhancing tumor. Treatment was continued and led to a stable disease until June 2010. Then MRI showed again a tumor progression. A palliative treatment with procarbacine and lomustin was initiated which failed in October 2010 showing progressive disease expanding into the cervical medulla. A re-irradiation combined with TMZ daily and celecoxib was not able to stop the progressive tumor. Despite the fact being bound to a wheel-chair quality of life has been good all the time. In January 2011 during holidays in Portugal, a sudden blindness occurred. A CT scan in urgency showed a diffuse tumor infiltration of the brain. The following day the patient became comatose and died in the night.

Conclusions: This report shows a long term follow up after aggressive treatment in a case of intramedullary GBM. Despite this malignant tumor the patient survived more than 48 months after start of the first symptoms of her disease. Thus, standard and palliative treatments like in cerebral GBM may allow a long time survival in intramedullary GBM.