Clinical Presentation and Treatment Outcome of Multicentric Glioblastomas: A Case Series
TL;DR
Although outcomes remain poor, patients receiving multimodal therapy appeared to have longer survival, although interpretation is limited by small sample size.
Abstract
Abstract Background Multicentric glioblastoma (MCG) is a rare and aggressive form of brain parenchymal malignancy, with limited evidence guiding its optimal management. A trimodality treatment approach—comprising surgery, radiotherapy, and chemotherapy—appears to offer better clinical outcomes compared with partial treatment or supportive care alone. Objectives This study aimed to shed light on possible treatment strategies in patients with MCG and their clinical outcomes. Materials and Methods This is a retrospective case series of five patients diagnosed with MCG at our institution between January 2019 and December 2023. Patients were identified through a review of the institutional medical records department. Inclusion criteria were (1) histopathologically confirmed glioblastoma multiforme as per WHO classification, (2) radiological evidence of two or more spatially separate enhancing lesions in different brain regions with no connecting T2/FLAIR hyperintense signal, indicating absence of white matter tract dissemination or parenchymal continuity, consistent with MCG as per criteria, and (3) availability of complete clinical, radiological, and treatment data. All patients underwent pretreatment MRI with contrast, which was independently reviewed by two neuroradiologists. Surgical and oncological management decisions were made in multidisciplinary tumor board meetings. Molecular profiling, including methylguanine methyltransferase (MGMT) promoter methylation status and IDH1/IDH2 mutation status, was performed where available. Data collected included demographics, presenting symptoms, tumor locations, imaging findings, extent of surgical resection, adjuvant therapy, progression-free survival, and overall survival. Results Three patients underwent surgery, one underwent surgical biopsy, and one adult, being the exception—did not undergo any surgical intervention/biopsy. Three adults, except one adult and the pediatric patient, received radiation. All except one adult received temozolomide. The remaining adult patient who did not receive any treatment modality was a case of recurrent glioblastoma with multicentric disease, in a previously known case of solitary glioblastoma treated radically. This patient was kept on best supportive care. All the patients expired. Survival ranged from 3 to 14 months. The longest survivor (14 months) was an adult patient who underwent surgical resection followed by hypofractionated whole brain radiotherapy (30 Gy/10 fractions) and completed six cycles of adjuvant temozolomide. Patients receiving surgery followed by adjuvant therapy survived 11 to 14 months, whereas those receiving limited or no treatment had shorter survival (3–6 months). Conclusion Although outcomes remain poor, patients receiving multimodal therapy appeared to have longer survival, although interpretation is limited by small sample size. Larger studies are required to validate these findings.