Abstract
Background
Multicentric malignant gliomas are well-separated tumours in different lobes or hemispheres, without anatomical continuity between lesions. The purpose of this study was to explore the clinical features, the pathology and the outcome according to the management strategies in a consecutive series of patients treated at a single institution. In addition, an analysis of the existing literature is presented.
Methods
For the institutional analysis, a retrospective review of all patients who underwent treatment for multicentric gliomas in the last 7 years was performed. For the analysis of the literature, a MEDLINE search with no date limitations was accomplished for surgical treatment of multicentric malignant gliomas.
Results
Two hundred and thirty-nine patients with glioma were treated in our department. Eighteen patients (7.5 %) with a mean age of 64 years (age range, 37–78 years) presented multicentric malignant gliomas. Thirteen patients (72 %) underwent surgical resection of at least one lesion that was followed by adjuvant treatment in all but one case. Five patients (28 %) underwent stereotactic biopsy and thereafter received chemotherapy. A survival advantage was associated with resection of at least one lesion followed by adjuvant treatment (median overall survival 12 months) compared with 4 months for stereotactic biopsy followed by chemotherapy. Similar results were obtained from the review of the literature.
Conclusions
Resection of at least one lesion seems to play a significant role in the management of selected patients with multicentric malignant gliomas. Multi-institutional studies on larger series are warranted to define how aggressively the patients with malignant multicentric gliomas should be treated.
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References
Batzdorf U, Malamud N (1963) The problem of multicentric gliomas. J Neurosurg 20:122–136
Barnard RO, Geddes JF (1987) The incidence of multifocal cerebral gliomas. A histologic study of large hemisphere sections. Cancer 60:1519–1531
Djalilian HR, Shah MV, Hall WA (1999) Radiographic incidence of multicentric malignant gliomas. Surg Neurol 51:554–558
Hefti M, von Campe G, Schneider C, Roelcke U, Landolt H (2010) Multicentric tumor manifestations of high grade gliomas: independent proliferation or hallmark of extensive disease? Cen Eur Neurosurg 71(1):20–25
Salvati M, Caroli E, Orlando ER, Frati A, Artizzu S, Ferranti L (2003) Multicentric glioma: our experience in 25 patients and critical review of the literature. Neurosurg Rev 26:275–279
Terakawa Y, Yordanova YN, Tate MC, Duffau H (2013) Surgical management of multicentric diffuse low-grade gliomas: functional and oncological outcomes: clinical article. J Neurosurg 118:1169–1175
Reagan TJ, Frieman IS (1973) Multiple cerebral gliomas in multiple sclerosis. J Neurol Neurosurg Psychiatry 36:523–528
Sawaya R, Hammoud M, Schoppa D, Hess KR, Wu SZ, Shi WM, Wildrrick DM (1998) Neurosurgical ouctomes in a modern series of 400 craniotomies for treatment of parenchymal tumors. Neurosurgery 42:1044–1055
Lacroix M, Abi-Said D, Fourney DR, Gokaslan ZL, Shi W, DeMonte F, Lang FF, McCutcheon IE, Hassenbusch SJ, Holland E, Hess K, Michael C, Miller D, Sawaya R (2001) A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg 95(2):190–198
Chadduck WM, Roycroft D, Brown MW (1983) Multicentric glioma as a cause of multiple cerebral lesions. Neurosurgery 13:170–175
Kato T, Aida T, Abe H, Ogata A, Nakamura N, Nagashima K, Kitaoka K (1990) Clinicopathological study of multiple gliomas—report of three cases. Neurol Med Chir (Tokyo) 30:604–609
Franco CM, Malheiros SM, Nogueira RG, Batista MA, Santos AJ, Abdala N, Stavale JN, Ferraz FA, Gabbai AA (2000) Multiple gliomas. Illustrative cases of 4 different presentations. [Article in Portuguese] Arq Neuropsiquiatr 58(1):150–156
Synowitz M, von Eckardstein K, Brauer C, Hoch HH, Kiwit JC (2002) Case history: multicentric glioma with involvement of the optic chiasm. Clin Neurol Neurosurg 105:66–68
Jawahar A, Weilbaecher C, Shorter C, Stout N, Nanda A (2003) Multicentric glioblastoma multiforme determined by PET: a case report. Clin Neuro Neurosurg 106:38–40
Iza B, Mateo-Sierra O, Ruiz-Juretszke F, Garbizu J, Guzmán de Villoria J, Carrillo R (2006) Familiar glioblastoma presenting as a true multicentric tumor: etiopathogenic and prognostic features [Article in Spanish]. Neurocirugía (Astur) 17:340–347
Ampil F, Burton GV, Gonzalez-Toledo E, Nanda A (2007) Do we need whole brain irradiation in multifocal or multicentric high-grade glioma? Review of cases and literature. J Neuorooncol 85:353–355
Colavolpe C, Guedj E, Metellus P, Barrie M, Figarella-Branger D, Mundler O, Chinot O (2008) FDG-PET to predict different patterns of progression in multicentric glioblastoma: a case report. J Neuroncol 90:47–51
Hassaneen W, Levine NB, Suki D, Salaskar AL, de Moura LA, McCutcheon IE, Prabhu SS, Lang FF, DeMonte F, Rao G, Weinberg JS, Wildrick DM, Aldape KD, Sawaya R (2011) Multiple craniotomies in the management of multifocal and multicentric glioblastoma. Clinical article. J Neurosurg 114:576–584
Bradley WL (1880) Case of gliosarcomatous tumors of the brain. Proc Conn Med Soc 2:39–41
Thomas RP, Xu LW, Lober RM, Li G, Nagpal S (2013) The incidence and significance of multiple lesions in glioblastoma. J Neurooncol 112(1):91–97
Patil CG, Eboli P, Hu J (2012) Management of multifocal and multicentric gliomas. Neurosurg Clin N Am 23:343–350
Stuckey SL, Wijedeera R (2008) Multicentric/multifocal cerebral lesions: can fluid-attenuated inversion recovery aid the differentiation between glioma and metastases? J Med Imaging Radiat Oncol 52(2):134–139
Budka H, Podreka I, Reisner T, Zeiler K (1980) Diagnostic and pathomorphological aspects of glioma multiplicity. Neurosurg Rev 3:230–241
Courville CB (1936) Multiple primary tumors of the brain. Review of the literature and report of twenty-one cases. Am J Cancer 26:703–731
Nakhl F, Chang EM, Shiau JS, Alastra A, Wrzolek M, Odaimi M, Raden M, Juliano JE (2010) A patient with multiple synchronous gliomas of distinctly different grades and correlative radiographic findings. Surg Neurol Int 16(1):48
Turola MC, Schivalocchi R, Ramponi V, De Vito A, Nanni MG, Frivoli GF (2009) A rare case of multicentric synchronous bi-frontal glioma in a young female. Diagnostic and therapeutic problems. Cases J 2(1):81
Sanai N, Berger MS (2008) Glioma extent of resection and its impact on patient outcome. Neurosurgery 62:753–764
Sanai N, Polley MY, McDermott MW, Parsa AT, Berger MS (2011) An extent of resection threshold for newly diagnosed glioblastomas. J Neurosurg 115(1):3–8
Gulati S, Jakola AS, Nerland US, Weber C, Solheim O (2011) The risk of getting worse: surgically acquired deficits, perioperative complications, and functional outcomes after primary resection of glioblastoma. World Neurosurg 76(6):572–579
McGirt MJ, Chaichana KL, Gathinji M, Attenello FJ, Than K, Olivi A, Weingart JD, Brem H, Quiñones-Hinojosa AR (2009) Independent association of extent of resection with survival in patients with malignant brain astrocytoma. J Neurosurg 110:156–162
Sarkar A, Chiocca EA (2011) Multiple craniotomies. J Neurosurg 114(3):574–575, discussion 575
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di Russo, P., Perrini, P., Pasqualetti, F. et al. Management and outcome of high-grade multicentric gliomas: a contemporary single-institution series and review of the literature. Acta Neurochir 155, 2245–2251 (2013). https://doi.org/10.1007/s00701-013-1892-9
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DOI: https://doi.org/10.1007/s00701-013-1892-9