Original ArticlePrimary Spinal Cord Glioblastoma Multiforme: A Retrospective Study of Patients at a Single Institution
Introduction
Among adults, glioblastoma multiforme (GBM) is the most common primary malignant tumor of central nervous system. Nevertheless, most GBMs occur in brain. Primary spinal cord (PSC) GBM is extremely rare, accounting for only 1.5% of all spinal cord tumors.1, 2 To the best of our knowledge, the literature on this topic published in the last 10 years is mainly restricted to single case reports or small case series. The report on the largest-scale PSC GBM case of adults to date is a single-center clinical retrospective study (involving 6 patients) with a long time span from 1990 to 2015.3 The prognosis of GBM is still poor despite progress in the treatment of gliomas. The overall survival (OS) of patients with PSC GBM is approximately 10–12 months. In contrast, its intracranial counterpart has a better prognosis of 15–22 months.4 PSC GBM would result in death as a result of its complications related to progressive involvement, respiratory impairment, and cerebral metastases.5 Only limited information about PSC GBM is available because of the lack of cases. To identify the natural history and clinical therapeutic factors that influence the prognosis of tumor, we performed a single-institutional study of the largest series of PSC GBM to date and reviewed previous reports.
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Patient Selection
After obtaining approval from the ethics review board, we carried out a retrospective review of the patients of West China Hospital with primary intramedullary spinal cord tumors and pathologic diagnoses of GBM during the period between 2008 and 2014. Fourteen patients with PSC GBM were identified. All patients were evaluated with enhanced brain and spinal magnetic resonance imaging before the operation and given maximal safe resection during the operation. Demographic and clinical
Patient Characteristics
The clinical features of the 14 patients with PSC GBM are shown in Table 1. Eight males (57%) and 6 females (43%) were involved in the current study. Their median age was 28 years (range, 14–56 years). Median KPS score was 60 (range, 20–90). The tumors were located in cervical (n = 3, 21%), cervicothoracic (n = 1, 8%), thoracic (n = 4, 29%), thoracolumbar (n = 3, 21%), lumbar (n = 3, 21%), and non–conus medullaris/cauda equina region. The most frequent symptoms included neck, chest and waist
General Aspects
GBM is the most common primary malignant brain tumor in adults. However, their metastases to spinal cord or primary spinal locations are rare. Although our study is a single-institutional review of the largest series of PSC GBM to date, these 14 patients represent only less than 1% of all patients with intramedullary neoplasms treated in our institution. Different from brain GBM, treatment and prognosis of PSC GBM are still controversial because of the paucity of large case series.2, 4 We
Conclusions
The treatment outcome of PSC GBM remains poor, and its successful treatment is still a formidable and inevitable task. In accordance with the result of this single-center retrospective study, radiotherapy in combination with postoperative chemotherapy is the major prognostic factor for longer survival. However, the EOR does not have any relevance. Instead, GTR may worsen the deficits in some cases. For us, this is a preliminary retrospective study based on the analysis of limited samples and
References (30)
- et al.
Spinal cord glioblastoma: 25 years of experience from a single institution
J Clin Neurosci
(2016) - et al.
Spinal glioblastoma multiforme
Hematol Oncol Stem Cell Ther
(2014) - et al.
Poor prognosis despite aggressive treatment in adults with intramedullary spinal cord glioblastoma
J Clin Neurosci
(2015) - et al.
Malignant astrocytomas of the spinal cord
J Neurosurg
(1989) - et al.
Prognostic factors and survival in primary malignant astrocytomas of the spinal cord: a population-based analysis from 1973 to 2007
Spine
(2012) - et al.
A systematic review on the characteristics, treatments and outcomes of the patients with primary spinal glioblastomas or gliosarcomas reported in literature until March 2015
PLoS One
(2016) - et al.
Prognostic factors in intramedullary astrocytomas: a literature review
Eur Spine J
(2009) - et al.
Histopathologic and immunohistochemical profile of spinal glioblastoma: a study of six cases
Brain Tumor Pathol
(2011) - et al.
Recurrent spinal cord glioblastoma: salvage therapy with bevacizumab
J Neurooncol
(2011) - et al.
A case of cervical spinal cord glioblastoma diagnosed with MR diffusion tensor and perfusion imaging
J Neuroimaging
(2011)
Spinal cord glioblastoma induced by radiation therapy of nasopharyngeal rhabdomyosarcoma with MRI findings: case report
Korean J Radiol
Primary spinal cord glioblastoma multiforme: a report of two cases
Neurol India
Primary spinal glioblastoma: a case report and review of the literature
Oncol Lett
An extremely rare case of glioblastoma multiforme of the spinal cord
Medicina (Kaunas)
Paediatric spinal glioblastoma: case report and review of therapeutic strategies
Childs Nerv Syst
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Xing Cheng and Silong Lou contributed equally to this work and are co-first authors.