title: Leptomeningeal and intramedullary metastases of glioblastoma multiforme in a patient reoperated during adjuvant radiochemotherapy.
abstract: Despite huge advances in medicine, glioblastoma multiforme (GBM) remains a highly lethal, fast-growing tumour that cannot be cured by currently available therapies. However, extracranial and extraneural dissemination of GBM is extremely rare, but is being recognised in different imaging studies. To date, the cause of the GBM metastatic spread still remains under discussion. It probably develops at the time of intracranial progression following a surgical procedure. According to other hypothesis, the metastases are a consequence of spontaneous tumour transdural extension or haematogenous dissemination. We present a case of a 59-year-old woman with symptomatic leptomeningeal and intramedullary metastases of GBM who has been previously surgically treated with primary subtotal resection and underwent a repeated surgery during adjuvant radiotherapy and chemotherapy with temozolomide. Today, the main goal of surgery and chemoradiotherapy is to prevent neurologic deterioration and improve health-related quality of life. With this paper, we want to present this rare entity and emphasise the importance of a multidisciplinary approach, a key function in the management of brain tumour patients. The prognosis is still very poor although prolongation of survival can be obtained. Finally, although rare, our case strongly suggests that clinicians should be familiar with the possibility of the extracranial spread of GBM because as treatment improvements provide better control of the primary tumour and improving survival, metastatic disease will be increasingly encountered.
authors.affiliation: Department of Oncology, University Hospital Centre (KBC Zagreb), University of Zagreb School of Medicine, Kispaticeva 12, Zagreb HR-10000, Croatia. josipjoachimgrah@yahoo.com
authors.forename: Josip Joachim
authors.initials: JJ
authors.lastname: Grah
authors.forename: Darko
authors.initials: D
authors.lastname: Katalinic
authors.forename: Ranka
authors.initials: R
authors.lastname: Stern-Padovan
authors.forename: Josip
authors.initials: J
authors.lastname: Paladino
authors.forename: Fedor
authors.initials: F
authors.lastname: Santek
authors.forename: Antonio
authors.initials: A
authors.lastname: Juretic
authors.forename: Kamelija
authors.initials: K
authors.lastname: Zarkovic
authors.forename: Stjepko
authors.initials: S
authors.lastname: Plestina
authors.forename: Marijana
authors.initials: M
authors.lastname: Supe
mesh_terms: D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000473:pathology / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant; D003131:Combined Modality Therapy; D003606:Dacarbazine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D005909:Glioblastoma / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008577:Meningeal Neoplasms / Q000556:secondary / Q000628:therapy*; D008875:Middle Aged; D018908:Muscle Weakness; D011379:Prognosis; D012086:Reoperation; D013120:Spinal Cord Neoplasms / Q000556:secondary / Q000628:therapy*; D000077204:Temozolomide
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide