title: Diagnosis and Management of Spinal Metastasis of Glioblastoma.
abstract: BACKGROUND
  When patients with cranial glioblastoma develop weakness, a rare differential diagnosis is spinal metastases.
  
  
  METHODS
  Chart and literature reviews were performed.
  
  
  RESULTS
  The reported patient had delayed onset spinal drop metastasis that was only detected by magnetic resonance imaging (MRI). A 48-year-old patient had supratentorial glioblastoma, treated with radiotherapy (RT) and concurrent temozolomide followed by six cycles of adjuvant temozolomide. Four years after completion of all treatments (62 months from initial presentation), he developed low backache and weakness in both legs. Positron emission tomography/computed tomography scans demonstrated intracranial recurrence only. Spinal drop metastases were detected only by MRI scan. Local spinal RT 40 Gy in 20 fractions with concurrent and maintenance temozolomide were given. Because of disease progression after nine cycles of temozolomide, systemic therapy was changed to bevacizumab, which greatly improved his symptoms for 4 months before deterioration of mental status. He is still alive with disease at 22 months after diagnosis of spinal metastases (84 months from initial glioblastoma diagnosis).
  
  
  CONCLUSIONS
  MRI is the diagnostic imaging of choice for spinal metastases. This illustrative case of delayed-onset spinal metastases shows unusual slow progression. Local RT, temozolomide, and targeted therapy may improve survival. This illustrative case is the first report of bevacizumab as a second-line therapy in drop metastasis of glioblastoma.
authors: 1Allan Blair Cancer Center,Regina,Saskatchewan.
authors: Patricia
authors: P
authors: Tai
authors: 2CancerCare Manitoba,Winnipeg,Manitoba.
authors: Arbind
authors: A
authors: Dubey
authors: 1Allan Blair Cancer Center,Regina,Saskatchewan.
authors: Muhammad
authors: M
authors: Salim
authors: 3Maisonneuve-Rosemont Hospital,Montreal,Quebec.
authors: Khanh
authors: K
authors: Vu
authors: 2CancerCare Manitoba,Winnipeg,Manitoba.
authors: Rashmi
authors: R
authors: Koul
mesh_terms: D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000008:administration & dosage; D001932:Brain Neoplasms / Q000473:pathology / Q000628:therapy; D059248:Chemoradiotherapy; D003606:Dacarbazine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005909:Glioblastoma / Q000175:diagnosis / Q000556:secondary / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods; D013125:Spinal Neoplasms / Q000175:diagnosis* / Q000556:secondary / Q000628:therapy*; D000077204:Temozolomide
chemical_list: D018906:Antineoplastic Agents, Alkylating; D000068258:Bevacizumab; D003606:Dacarbazine; D000077204:Temozolomide
keywords: Brain tumors; glioma; neuro-oncology - medical; neuroimaging; radiation; radiation oncology