title: Pattern of recurrence and factors associated with cerebrospinal fluid dissemination of glioblastoma in Chinese patients.
abstract: BACKGROUND
  Pattern of recurrence of glioblastoma (GBM) seems to have undergone some shifts from distant metastasis as a rarity to a higher proportion, including disease disseminated via cerebrospinal fluid (CSF) pathway. There is still no report on the pattern of recurrence for Chinese population. Here, we evaluated the pattern of recurrence of GBM in Chinese patients along with factors that could affect the distribution of recurrence.
  
  
  METHODS
  Medical records of GBM patients with definite recurrence were reviewed. Local recurrence was defined as tumor regrowth within the preoperative abnormal signals on magnetic resonance imaging (MRI) T2 sequence. New recurrence was a new lesion away from the preoperative T2 abnormalities. New recurrence in contact with CSF pathways was registered as new CSF dissemination. Progress-free survival (PFS) and survival after progress were compared using the Kaplan-Meier survival curves. Potential risk factors for new CSF dissemination were assessed using univariate models followed by multivariate analysis.
  
  
  RESULTS
  Thirty-six patients were proven to have recurrence; 22 local and 14 new recurrences. Among the 14 patients, 11 had new CSF dissemination. Median PFS for local, new parenchymal recurrence, and new CSF dissemination were 5.5 months, 9.9 months, and 12.1 months, whereas survival after progress were 6.1 months, 5.7 months, and 16.9 months, respectively. The ventricular entry during surgery and the completion of concomitant chemoradiotherapy were risk factors for new CSF dissemination. O6-methylguanine-DNA methyltransferase methylation was associated with the development of CSF dissemination.
  
  
  CONCLUSIONS
  The majority of recurrence remained local (22/36, 61%). However, CSF dissemination was up to 30% (11/36). PFS for patients with CSF dissemination was the longest, and paradoxically survival after progress was the shortest. Ventricular entry should be avoided. Whole craniospinal MRI surveillance should be included for these patients.
authors.affiliation: CUHK Otto Wong Brain Tumor Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Danny T M
authors.initials: DT
authors.lastname: Chan
authors.affiliation: CUHK Otto Wong Brain Tumor Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Sonia Y P
authors.initials: SY
authors.lastname: Hsieh
authors.affiliation: Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Michael K M
authors.initials: MK
authors.lastname: Kam
authors.affiliation: Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Tom C Y
authors.initials: TC
authors.lastname: Cheung
authors.affiliation: CUHK Otto Wong Brain Tumor Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Stephanie Chi P
authors.initials: SC
authors.lastname: Ng
authors.affiliation: CUHK Otto Wong Brain Tumor Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Wai S
authors.initials: WS
authors.lastname: Poon
keywords: CSF dissemination; glioblastoma; pattern of recurrence