title: Extra central nervous system metastases from cerebral glioblastoma multiforme in elderly patients. Clinico-pathological remarks on our series of seven cases and critical review of the literature.
abstract: OBJECTIVE
  The aim of the study was to evaluate the treatment of the extracranial metastases from glioblastoma multiforme in the elderly, discussing their uncommon occurrence and their pathogenesis.
  
  
  METHODS
  The authors report seven cases of elderly patients (mean age, 69 years), with an initial diagnosis of cerebral glioblastoma multiforme, treated by a grossly total surgical removal and followed by adjuvant radiotherapy (64 Gy in 6 weeks, using Linac) and adjuvant chemotherapy (temozolomide both concomitant and sequential to radiotherapy).
  
  
  RESULTS
  All patients presented a postoperative course characterized by good functional and clinical conditions (Karnofsky performance scale > or =70), which remained unchanged for a mean period of about 21 months (range, 16-23), with no neuroradiological signs of lesion regrowth. After this interval, new clinical signs occurred, and their clinical and radiological investigation showed metastatic repetitions in different sites: lung, liver, humerus and lymph nodes. All the metastases were surgically treated, but regrowth of the brain tumor and progression to deep important neural structures caused the patients' exitus after a mean interval of about 10 months (range, 8-12) from the diagnosis of metastasis.
  
  
  CONCLUSIONS
  We found 128 cases of extra CNS metastases in the English literature. The main features of the patients of the previous reports and of those of the present series were analyzed. The main modalities of glioblastoma multiforme spread, the few theories about the rarity of metastasis, and the probable biological, histological and immunogenetic mechanisms involved in the pathogenesis are described. Although several studies have reported a poor outcome in elderly patients, they affirm that the treatment of those with a Karnofsky performance status >60 should be just as aggressive as in younger patients. This allows them to obtain a longer survival time and to also treat metastases, which are uncommon particularly in the elderly.
authors.affiliation: Department of Neurological Sciences-Neurosurgery, University of Rome Sapienza, Rome, Italy. manolopiccirilli@libero.it
authors.forename: Manolo
authors.initials: M
authors.lastname: Piccirilli
authors.forename: Giacoma Maria Floriana
authors.initials: GM
authors.lastname: Brunetto
authors.forename: Giovanni
authors.initials: G
authors.lastname: Rocchi
authors.forename: Felice
authors.initials: F
authors.lastname: Giangaspero
authors.forename: Maurizio
authors.initials: M
authors.lastname: Salvati
mesh_terms: D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000473:pathology* / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D005909:Glioblastoma / Q000556:secondary* / Q000628:therapy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000628:therapy; D008175:Lung Neoplasms / Q000556:secondary* / Q000628:therapy; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D018714:Radiotherapy, Adjuvant; D000077204:Temozolomide
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide