Symptomatic leptomeningeal and intramedullary metastases from intracranial glioblastoma multiforme: a case report.
BACKGROUND
Glioblastoma multiforme infrequently metastasizes to the leptomeninges and even more rarely to the spinal cord. Moreover, very few patients with intracranial glioblastoma develop symptoms from spinal dissemination, with most patients not surviving long enough for spinal disease to become clinically evident.


METHODS
We present a rare case of symptomatic diffuse spinal leptomeningeal metastases simultaneously to an intramedullary lesion from an intracranial glioblastoma multiforme. After the diagnosis of spinal metastases the patient was treated with limited-field spinal radiotherapy (30 Gy in 3-Gy fractions).


RESULTS
Radiotherapy on the main spinal lesions provided either relief from pain or mild improvement of neurological deficits. The patient died due to intracranial progression 4 months after diagnosis of spinal seeding and 17 months after diagnosis of the primary disease. We analyzed leptomeningeal and spinal metastases from glioblastoma multiforme with reference to the literature.


CONCLUSIONS
Radiotherapy for spinal disease may provide important symptom relief but the prognosis of these patients remains dramatically poor. As the local control of primary glioblastoma multiforme has improved with recent therapeutic advances, distant metastasis from high-grade gliomas is likely to become a more common clinical problem and such patients need to be included in clinical trials to evaluate new therapeutic approaches.
Scoccianti
Silvia
S
Department of Radiotherapy, University of Florence, Florence, Italy. silvia.scoccianti@unifi.it
Detti
Beatrice
B
Meattini
Icro
I
Iannalfi
Alberto
A
Sardaro
Angela
A
Leonulli
Barbara Grilli
BG
Martinelli
Francesco
F
Bordi
Lorenzo
L
Pellicanò
Gianni
G
Biti
Giampaolo
G
D000328:Adult; D001932:Brain Neoplasms / Q000473:pathology* / Q000628:therapy; D005909:Glioblastoma / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000556:secondary* / Q000628:therapy; D013120:Spinal Cord Neoplasms / Q000556:secondary* / Q000628:therapy