title: Long-term tumor control of spinal dissemination of cerebellar glioblastoma multiforme by combined adjuvant bevacizumab antibody therapy: a case report.
abstract: BACKGROUND
  Glioblastoma multiforme located in the posterior fossa is extremely rare with a frequency up to 3.4%. Compared with glioblastoma of the hemispheres the prognosis of infratentorial glioblastoma seems to be slightly better. Absence of brainstem invasion and low expression rates of epidermal growth factor receptor are described as factors for long-time survival due to the higher radiosensitivity of these tumors.
  
  
  METHODS
  In this case study, we report a German female patient with an exophytic glioblastoma multiforme arising from the cerebellar tonsil and a secondary spinal manifestation. Furthermore, the tumor showed no O (6)-Methylguanine-DNA methyltransferase promotor-hypermethylation and no isocitrate dehydrogenase 1 mutations. All these signs are accompanied by significantly shorter median overall survival. A long-term tumor control of the spinal metastases was achieved by a combined temozolomide/bevacizumab and irradiation therapy, as part of a standard care administered by the treating physician team.
  
  
  CONCLUSIONS
  To our knowledge this is the first published case of a combined cerebellar exophytic glioblastoma with a subsequent solid spinal manifestation. Furthermore this case demonstrates a benefit undergoing this special adjuvant therapy regime in terms of overall survival. Due to the limited overall prognosis of the disease, spinal manifestations of glioma are rarely clinically relevant. The results of our instructive case, however, with a positive effect on both life quality and survival warrant treating future patients in the frame of a prospective clinical study.
authors.affiliation: Department of Neurosurgery, Julius-Maximilians-University, 97080 Wuerzburg, Germany. Linsenmann_T@ukw.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Linsenmann
authors.forename: Camelia M
authors.initials: CM
authors.lastname: Monoranu
authors.forename: Giles H
authors.initials: GH
authors.lastname: Vince
authors.forename: Thomas
authors.initials: T
authors.lastname: Westermaier
authors.forename: Carsten
authors.initials: C
authors.lastname: Hagemann
authors.forename: Almuth F
authors.initials: AF
authors.lastname: Kessler
authors.forename: Ralf-Ingo
authors.initials: RI
authors.lastname: Ernestus
authors.forename: Mario
authors.initials: M
authors.lastname: Löhr
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000068258:Bevacizumab; D004576:Electromyography; D005260:Female; D005909:Glioblastoma / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D013125:Spinal Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000556:secondary*
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab
references.citation: Anticancer Res. 2006 Mar-Apr;26(2B):1351-7
references.pmid: 16619544
references.citation: N Engl J Med. 2001 Jan 11;344(2):114-23
references.pmid: 11150363
references.citation: Surg Neurol. 2005 Feb;63(2):162-9; discussion 169
references.pmid: 15680662
references.citation: Int J Neurosci. 2012 Nov;122(11):691-4
references.pmid: 22720749
references.citation: Neurologia. 2007 Apr;22(3):159-69
references.pmid: 17364254
references.citation: Neurosurgery. 1990 Oct;27(4):516-21; discussion 521-2
references.pmid: 2172859
references.citation: AJNR Am J Neuroradiol. 1995 Mar;16(3):583-9
references.pmid: 7793385
references.citation: J Neurosurg Spine. 2012 Nov;17(5):438-48
references.pmid: 22958073
references.citation: J Neurosurg. 2005 Mar;102(3):540-2
references.pmid: 15796392
references.citation: Neurol Med Chir (Tokyo). 1997 May;37(5):411-5
references.pmid: 9184441
references.citation: N Engl J Med. 2005 Mar 10;352(10):987-96
references.pmid: 15758009
references.citation: Acta Neurochir (Wien). 2009 Jun;151(6):653-7
references.pmid: 19319469
references.citation: Int J Radiat Oncol Biol Phys. 2006 Sep 1;66(1):179-86
references.pmid: 16814953