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Diagnosis and Management of Spinal Metastasis of Glioblastoma

  • Patricia Tai (a1), Arbind Dubey (a2), Muhammad Salim (a1), Khanh Vu (a3) and Rashmi Koul (a2)...
Abstract
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.

RÉSUMÉ

Diagnostic et prise en charge de métastases spinales d’un glioblastome. Contexte: Quand des patients atteints d’un glioblastome cérébral présentent de la faiblesse, le diagnostic différentiel doit inclure des métastases spinales, bien que celles-ci soient rares. Méthode: Nous avons effectué une revue de dossiers ainsi que de la littérature à ce sujet. Résultats: Le patient âgé de 48 ans, dont nous rapportons les observations, a présenté tardivement des métastases spinales d’un glioblastome détectées seulement par imagerie par résonance magnétique (IRM). Il était porteur d’un glioblastome sus-tentoriel traité simultanément par radiothérapie (RT) et témozolomide, suivi de six cycles de traitement adjuvant par le témozolomide. Quatre ans après la fin du traitement (62 mois après la consultation initiale), il a présenté une lombalgie et de la faiblesse au niveau des deux membres inférieurs. Des scans par tomographie par émission de positons/tomodensitométrie n’ont montré que la récidive intracrânienne de la tumeur. Des métastases spinales ont été détectées au scan par IRM. Il a été traité par RT spinale locale 40 Gy en 20 fractions avec administration simultanée et à long terme de témozolomide. À cause de la progression de la maladie après neuf cycles de témozolomide, le traitement systémique a été modifié. Le bévacizumab a amélioré considérablement la symptomatologie pendant 4 mois avant que le patient ne présente une détérioration de son état mental. Il est toujours vivant 22 mois après le diagnostic des métastases spinales (84 mois après le diagnostic initial de glioblastome). Conclusions: L’IRM est la technique d’imagerie de choix pour détecter les métastases spinales. Il s’agit d’un cas où l’apparition de métastases spinales a été tardive, avec une lenteur inhabituelle de la progression. La RT locale, le témozolomide et un traitement ciblé peuvent améliorer la survie. Ceci constitue le premier cas rapporté de traitement par le bévacizumab administré en seconde intention pour des métastases spinales d’un glioblastome.

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Copyright
Corresponding author
Correspondence to: Patricia Tai, Department of Radiation Oncology, Allan Blair Cancer Center, 4101 Dewdney Avenue, Regina, SK S4T 7T1 Canada. E-mail: patricia.tai@saskcancer.ca.
References
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Canadian Journal of Neurological Sciences
  • ISSN: 0317-1671
  • EISSN: 2057-0155
  • URL: /core/journals/canadian-journal-of-neurological-sciences
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