Article
Spinal drop metastases of glioblastoma multiforme before and after introduction of the “Stupp” schema
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Authors
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Hajrullah Ahmeti
- Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
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Maximilian H. Mehdorn
- Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
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Andreas M. Stark
- Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| Published: | June 2, 2015 |
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Outline
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Objective: Glioblastoma multiforme (GBM) is the most common and most malignant primary brain tumor in adults. Metastatic lesions are rare. We investigated the occurrence of spinal drop metastases in patients with GBM before and after the introduction of combined radio-/chemotherapy with temozolomide according to the EORTC ("Stupp") schema.
Method: We performed a retrospective analysis including all patients, who have been operated on GBM (WHO IV) in our department between 1990 and 2014.
Results: We found a total of 740 patients with histologically proven GBM, who were treated within these 25 years in our department. Four patients were found to develop spinal drop metastases (0.54%). The median age of patients with spinal drop metastases was 57 years (range 20-64 years). The time interval between first surgery and the occurrence of spinal drop metastases was 5, 9, and 11 months, and 13 years. All of these patients were initially diagnosed and treated before introduction of the "Stupp" schema. One patient, however, has received temozolomide for local GBM recurrence. In this case, the time interval between initial surgery for GBM and the occurrence of spinal drop metastases was as long as 13 years.
In two patients, the spinal metastases were treated surgically with proven histological diagnosis. Spinal drop metastases were associated with a rapid deterioration of the clinical condition in all patients. Among the GBM patients, who received radio-/chemotherapy according to "Stupp scheme", no one developed spinal drop metastases.
Conclusions: Spinal GBM drop metastases are rare. In our series we discovered four of 740 patients (0.54%) suffering from spinal drop metastases. All of these patients were initially treated before combined chemo/radiotherapy with temozolomide was available. One patient, however, received temozolomide for local GBM recurrence. There were no spinal drop metastases detected in patients, who were treated according to the "Stupp" schema.
