gms | German Medical Science

Objective: Multifocal glioblastomas are a special challenge regarding an ideal surgical management. Today there is no generally admitted concept for surgical treatment of multifocal glioblastomas. Common studies of high grade gliomas usually exclude patients with multifocal lesions because of the limited chance of resection and a mostly bad Karnofsky Performance Status Scale. The aim of this examination was to identify prognostic factors and the clinical course of patients with multifocal glioblastomas.

Method: In this retrospective study we included patients who received a surgical resection or biopsy of a newly diagnosed intracranial multifocal glioma between 2008 and 2012. We identified 25 patients with 2 to 5 lesion of high grade glioma, whereas there was no conjunction of T2 Flair weighted areas shown in MRI at least between two of them. We assessed the kind of surgical treatment, extent of resection, survival and clinical status.

Results: 18 patients received surgical partial tumor resection. A biopsy has been performed in 7 cases. Mean age was 61 years. 16 were male, 9 were female. In 16 cases there were two, in 9 cases more than three multifocal lesions. Mean survival from tumor diagnosis was 238 days, median survival was 166 days. Mean preoperative Karnofsky Performance Status Scale was 74, 8, mean postoperative Karnofksy Performance Status Scale was 68, 4. We disclosed a trend regarding a shorter survival for patients with 3 or more lesions (median: 52 days ± 34) compared to patients with only 2 lesions (median: 267 ± 100, 35) and a significant longer survival of patients with a Karnofksy Performance Status Scale > 70 % (median: 361 days ± 139, 16) than for patients with a Karnofksy Performance Status Scale lower than 70 % (median: 88 days ± 31, 76) (log rank 0,015). There was also a trend regarding a longer survival for patients with an extent of tumor resection more than 70 % (361 days ± 167,123) compared to patients with an extent of resection less than 70 % (median: 88 days ± 100,623) (log rank 0,260).

Conclusions: In patients with multifocal glioblastoma there is the need of an individual consideration and decision making regarding the surgical and non-surgical therapy for every patient. According to our patient cohort, survival decreases considerably in patients with 3 or more lesions. In spite of the unfavourable outcome of multifocal glioblastoma treating neurosurgeon has to consider surgical options and prognostic factors to offer every patient the best possible therapy.