title: The cause of death in patients with glioblastoma is multifactorial: clinical factors and autopsy findings in 117 cases of supratentorial glioblastoma in adults.
abstract: To delineate the causes of death (COD) in adults with supratentorial glioblastoma multiforme (GM) we reviewed 117 consecutive cases examined at autopsy over a nineteen year period at the University of Washington. Twenty cases (17%) had expired unexpectedly without ante mortem diagnosis, 5 patients (4%) had been diagnosed as having lower grade astrocytomas prior to death. Other than the 20 patients without ante mortem diagnosis, all patients had a surgical procedure for treatment and/or diagnosis (biopsy 10%, craniotomy 90%). Postsurgical therapy varied, but there was no significant difference in median length of survival among the different treatment groups. Factors considered as potential COD were: herniation (axial, transtentorial, subfalcine, tonsillar), surgical complications (death within thirty days of surgery secondary to cerebral hemorrhage and/or edema), severe systemic illness, brainstem invasion by tumor, and neutron-induced cerebral injury (cerebral and brainstem gliosis were evident in these cases). A potential COD could be identified in 93% of patients. Patients with no ante mortem diagnosis were likely to have herniated (p = 0.01), whereas patients who underwent neutron irradiation were unlikely to have herniated (p = 0.001). No other variables were statistically significant predictors of herniation, including multifocal tumors (20 patients), and brainstem invasion by tumor (18 patients). No patients died as a result of treatment except those who underwent neutron radiotherapy and those who died postoperatively. Although significant mass effect, as evidenced by herniation, was apparent in 61% of patients, most of these patients had an additional identifiable COD. We conclude that the COD in patients with GM varies and is multifactorial.
authors.affiliation: Department of Neurological Surgery, University of Washington Medical Center, Seattle 98195.
authors.forename: D L
authors.initials: DL
authors.lastname: Silbergeld
authors.forename: R C
authors.initials: RC
authors.lastname: Rostomily
authors.forename: E C
authors.initials: EC
authors.lastname: Alvord
mesh_terms: D001344:Autopsy; D001930:Brain Injuries / Q000209:etiology / Q000401:mortality; D001932:Brain Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D002423:Cause of Death; D003645:Death, Sudden / Q000209:etiology; D004677:Encephalocele / Q000209:etiology / Q000401:mortality; D005909:Glioblastoma / Q000150:complications / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D006801:Humans; D007239:Infections / Q000150:complications / Q000401:mortality; D009502:Neutrons / Q000009:adverse effects; D011183:Postoperative Complications / Q000401:mortality; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D014861:Washington / Q000453:epidemiology