Long-term tumor control of spinal dissemination of cerebellar glioblastoma multiforme by combined adjuvant bevacizumab antibody therapy: a case report.
Long-term tumor control of spinal dissemination of cerebellar glioblastoma multiforme by combined adjuvant bevacizumab antibody therapy: a case report.
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DOI：
10.1186/1756-0500-7-496
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发表时间：
2014-08-07
影响因子：
1.8
通讯作者：
Löhr M
中科院分区：
文献类型：
--
作者：
Linsenmann T;Monoranu CM;Vince GH;Westermaier T;Hagemann C;Kessler AF;Ernestus RI;Löhr M
位于后颅窝的多形性胶质母细胞瘤是非常罕见的，其发生率高达3.4%。与半球胶质母细胞瘤相比，幕下胶质母细胞瘤的预后似乎稍好。由于这些肿瘤的放射敏感性较高，脑干浸润的缺乏和表皮生长因子受体的低表达率被描述为长期生存的因素。在此病例研究中，我们报告一位德国女性患者，其外生性多形性胶质母细胞瘤起源于小脑扁桃体，并有继发性脊柱表现。此外，肿瘤显示没有O（6）-甲基鸟嘌呤-DNA甲基转移酶启动子高甲基化，没有异柠檬酸脱氢酶1突变。所有这些体征都伴随着中位总生存期显著缩短。脊柱转移瘤的长期肿瘤控制是通过替莫唑胺/贝伐单抗和放射治疗联合实现的，作为治疗医生团队管理的标准护理的一部分。据我们所知，这是第一个发表的情况下，结合小脑外生胶质母细胞瘤与随后的固体脊髓表现。此外，该病例证明了接受这种特殊辅助治疗方案在总生存期方面的益处。由于有限的整体预后的疾病，脊髓表现的神经胶质瘤很少有临床意义。然而，我们的指导性病例的结果对生活质量和生存率都有积极的影响，这保证了在前瞻性临床研究的框架内治疗未来的患者。
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. 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. 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.