title: Glioblastoma multiforme in patients with history of extracranial cancer: Case series.
abstract: OBJECTIVE
  Significant progress in treatment strategies improves the expectations of patients with extracranial cancers. Metastases are the primary consideration in patients with cancer history. In the case of neurologic disorders, the patient should undergo brain MRI. A rationale is presented for surgery, whole-brain or stereotactic radiotherapy, or chemotherapy. Recently, we have encountered misdiagnosed primary malignant brain tumours in patients with oncologic history who had been admitted for surgery for brain metastases. The aim of our study is to evaluate the incidence of concurrent cancers, to assess the relationship between previous cancer staging and primary brain tumour evaluation as well as to determine treatment efficiency.
  
  
  METHODS
  From January 2007 to December 2011, we prospectively followed up patients with concurrent history of both extracranial cancer and subsequent glioblastoma multiforme. Information was collected on the clinical condition, imaging, history of extracranial cancer, previous and present surgical and oncologic procedures, and GBM histologic, cytogenetic, and molecular genetic investigations.
  
  
  RESULTS
  Five patients were recruited: three females and two males. The average patient age at the time of GBM diagnosis was 65.6 years. Three patients had a history of breast carcinoma, one of renal carcinoma and one of colorectal carcinoma. Following the diagnosis of carcinoma, three patients received chemotherapy and radiotherapy, one patient had radiotherapy alone, and one had no adjuvant therapy. In all the cases, surgery revealed primary GBM, with a standard occurrence of genetic abnormalities (Table 1). The average time from the diagnosis of extracranial cancer to that of GBM was 4 years. Four patients underwent chemoradiotherapy and one had palliative radiotherapy. Two patients completed oncotherapy and their OS was 27 months and 19 months, respectively. One patient had post-surgical progression of hemiparesis. One patient had pulmonary embolism during oncotherapy and one had paraplegia caused by a pathological fracture of vertebras T5 due to breast carcinoma metastases. The OS was 11.8 months (range 3-27 months). All the patients succumbed to GBM progression.
authors.affiliation: Dpt. of Neurosurgery, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University in Olomouc, Czech Republic. Electronic address: ondrej.kalita@fnol.cz.
authors.forename: O
authors.initials: O
authors.lastname: Kalita
authors.affiliation: Institute of Molecular and Translational Medicine of Faculty of Medicine and Dentistry, Palacky University in Olomouc, Czech Republic.
authors.forename: R
authors.initials: R
authors.lastname: Trojanec
authors.affiliation: Institute of Molecular and Translational Medicine of Faculty of Medicine and Dentistry, Palacky University in Olomouc, Czech Republic.
authors.forename: M
authors.initials: M
authors.lastname: Megova
authors.affiliation: Institute of Molecular and Translational Medicine of Faculty of Medicine and Dentistry, Palacky University in Olomouc, Czech Republic.
authors.forename: M
authors.initials: M
authors.lastname: Hajduch
authors.affiliation: Dpt. of Neurosurgery, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University in Olomouc, Czech Republic.
authors.forename: M
authors.initials: M
authors.lastname: Vaverka
authors.affiliation: Dpt. of Neurosurgery, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University in Olomouc, Czech Republic.
authors.forename: L
authors.initials: L
authors.lastname: Hrabalek
authors.affiliation: Dpt. of Oncology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University in Olomouc, Czech Republic.
authors.forename: M
authors.initials: M
authors.lastname: Zlevorova
authors.affiliation: Institute of Molecular and Translational Medicine of Faculty of Medicine and Dentistry, Palacky University in Olomouc, Czech Republic.
authors.forename: J
authors.initials: J
authors.lastname: Drabek
authors.affiliation: Dpt. of Pathology and Laboratory of Molecular Pathology, Institute of Molecular and Translational Medicine of Faculty of Medicine and Dentistry, Palacky University in Olomouc, Czech Republic.
authors.forename: L
authors.initials: L
authors.lastname: Tuckova
authors.affiliation: Dpt. of Oncology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University in Olomouc, Czech Republic.
authors.forename: J
authors.initials: J
authors.lastname: Vrbkova
mesh_terms: D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005909:Glioblastoma / Q000000981:diagnostic imaging* / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed
keywords: Extracranial cancer; Glioblastoma Multiforme; Oncotherapy; Treatment strategy