title: Prognostic significance of intracranial dissemination of glioblastoma multiforme in adults.
abstract: OBJECTIVE
  The clinical outcome and treatment of adult patients with disseminated intracranial glioblastoma multiforme (GBM) is unclear. The objective in the present study was to assess the prognostic significance of disseminated intracranial GBM in adults at presentation and at the time of tumor progression.
  
  
  METHODS
  Clinical data from 1491 patients older than 17 years and harboring a GBM that had been diagnosed between 1988 and 1998 at the University of California at San Francisco neurooncology clinic were retrospectively reviewed. Dissemination of the GBM (126 patients) was determined based on Gd-enhanced magnetic resonance images. Classification of dissemination was as follows: Type I, single lesion with subependymal or subarachnoid spread; Type II, multifocal lesions without subependymal or subarachnoid spread; and Type III, multifocal lesions with subependymal or subarachnoid spread. Subgroups of patients were compared using Kaplan-Meier curves that depicted survival probability. The median postprogression survival (PPS), defined according to neuroimaging demonstrated dissemination, was 37 weeks for Type I (23 patients), 25 weeks for Type II (50 patients), and 10 weeks for Type III spread (19 patients). Patients with dissemination at first tumor progression (52 patients) overall had a shorter PPS than those in a control group with local progression, after adjusting for age, Kamofsky Performance Scale score, and time from tumor diagnosis to its progression (311 patients). When analyzed according to tumor dissemination type, PPS was significantly shorter in patients with Type II (33 patients, p < 0.01) and Type III spread (11 patients, p < 0.01) but not in those with Type I spread (eight patients, p = 0.18).
  
  
  CONCLUSIONS
  Apparently, the presence of intracranial tumor dissemination on initial diagnosis does not in itself preclude aggressive treatment if a patient is otherwise well. A single focus of GBM that later demonstrates Type I dissemination on progression does not have a worse prognosis than a lesion that exhibits only local recurrence.
authors.affiliation: Department of Neurological Surgery, School of Medicine, University of California at San Francisco, California 94143, USA. parsaa@neurosurg.ucsf.edu
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Parsa
authors.forename: Scott
authors.initials: S
authors.lastname: Wachhorst
authors.forename: Kathleen R
authors.initials: KR
authors.lastname: Lamborn
authors.forename: Michael D
authors.initials: MD
authors.lastname: Prados
authors.forename: Michael W
authors.initials: MW
authors.lastname: McDermott
authors.forename: Mitchel S
authors.initials: MS
authors.lastname: Berger
authors.forename: Susan M
authors.initials: SM
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000473:pathology* / Q000628:therapy; D018450:Disease Progression; D005260:Female; D005909:Glioblastoma / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis