title: Prolonged survival of a patient with cervical intramedullary glioblastoma multiforme treated with total resection, radiation therapy, and temozolomide.
abstract: We report a case of prolonged survival in a patient with cervical intramedullary glioblastoma multiforme (GBM) treated with total resection, radiotherapy, and temozolomide. A 26-year-old woman complaining of midline lower cervical pain, insidiously progressive motor weakness, paresthesia, and urinary incontinence was admitted to our institution. MRI showed an intramedullary mass lesion in the C2-C6 level, which was considered to be an ependymoma or astrocytoma. Total resection of the tumor was performed at the C2-C6 level by laminoplasty with miniplate, followed by chemoradiotherapy (focal irradiation dose of 5000, at 200 cGy per fraction for over a period of 5 weeks) with concomitant temozolomide (75 mg/m2). Histologic examination of the resected tumor confirmed GBM. The tumor consisted of a markedly pleomorphic neoplasm measuring 4.6 cm×2.6 cm×1.7 cm and characterized by necrosis, atypical mitotic figures, and endothelial proliferation. Postoperative MRI showed a centrally located, postoperative cavity at the C2-C6 level. Recurrence in the cervical spine without brain GBM metastasis was identified 25 months after operation, and temozolomide chemotherapy was reinitiated; however, the tumor progressed, and the patient died 33 months after operation. We suggest that, in addition to potential factors of tumor biology, multimodal treatment consisting of total resection of intramedullary GBM coupled with radiation therapy and temozolomide may have prolonged the survival of this patient.
authors.affiliation: Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taiwan.
authors.forename: Han-Min
authors.initials: HM
authors.lastname: Tseng
authors.forename: Lu-Ting
authors.initials: LT
authors.lastname: Kuo
authors.forename: Huang-Chun
authors.initials: HC
authors.lastname: Lien
authors.forename: Kao-Lang
authors.initials: KL
authors.lastname: Liu
authors.forename: Mu-Tai
authors.initials: MT
authors.lastname: Liu
authors.forename: Chao-Yuan
authors.initials: CY
authors.lastname: Huang
mesh_terms: D000328:Adult; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000009:adverse effects; D001706:Biopsy; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003606:Dacarbazine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D018450:Disease Progression; D018572:Disease-Free Survival; D017809:Fatal Outcome; D005260:Female; D005909:Glioblastoma / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D019635:Neurosurgical Procedures; D011878:Radiotherapy; D013120:Spinal Cord Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D000077204:Temozolomide
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide