Selahattin MENTEŞ, Feryal KARACA, Ali ARSLAN, Muhammet Ahmet GÜLDÜR, Berna Bozkurt DUMAN

Treatment of a Rare Intramedullary Primary Spinal Glioblastoma Multiforme Lesion in an Adult Patient

Primary spinal cord tumors represent 2%–10% of all central nervous system tumors and mainly comprise astrocytoma, ependymoma, ganglioglioma, oligodendroglioma and subependymoma. Only 1%–3% of all spinal cord tumors show primary glioblastoma multiforme pathology. Methods: Spinal glioblastoma multiforme was diagnosed as a result of MRI findings of the patient (The thoracic spinal MR revealed an intramedullary nodular expansile lesion), who had numbness in lower extremities. Maximum safe resection was performed our patient. The lesion reported as GBM. Adjuvant radiotherapy and chemotherapy including temozolomide was applied subsequently. The primary treatment of spinal glioblastoma multiforme includes surgery, radiotherapy and chemotherapy. Despite multidisciplinary approaches available to treat spinal glioblastoma multiforme, the prognosis remains poor, with survival rates of 10–12 months. Total resection is nevertheless the main therapy for spinal glioblastoma multiforme in spite of current developments. Although spinal intramedullary glioblastoma multiforme particularly is quite rare, its treatment is very difficult.

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1. Cheng X, Lou S, Huang S, Chen H, Liu J. Primary spinal cord glioblastoma multiforme: a retrospective study of patients at a single institution. World Neurosurg 2017; 106: 113- 119.

2. Adams H, Avendaño J, Raza SM, Gokaslan ZL, Jallo GI, Quiñones-Hinojosa A. Prognostic factors and survival in primary malignant astrocytomas of the spinal cord. Spine (Phila Pa 1976) 2012; 37: 727-735.

3. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC)." Cox JD et al. Int J Radiatıon Oncol Biol Phys. Version 1995; 30: 1341-1346.

4. McGirt MJ, Goldstein IM, Chaichana KL, Tobias ME, Kothbauer KF, Jallo GI. Extent of surgical resection of malignant astrocytomas of the spinal cord: outcome analysis of 35 patients. Neurosurgery 2008; 63: 55-60.

5. Seki T, Hida K, Yano S, Aoyama T, Koyanagi I, Houkin K. Surgical Outcomes of HighGrade Spinal Cord Gliomas. Asian Spine J. 2015; 9: 935-941 . 6. Minehan KJ, Brown PD, Scheithauer BW, Krauss WE, Wright MP. Prognosis and treatment of spinal cord astrocytoma. Int J Radiat Oncol Biol Phys 2009; 73: 727-733.

7. Shirato H, Kamada T, Hida K, Koyanagi I, Iwasaki Y, Miyasaka K, et al. The role of radiotherapy in the management of spinal cord glioma. Int J Radiat Oncol Biol Phys 1995; 33: 323-328.

8. Katoh N, Shirato H, Aoyama H, et al. Hypofractionated radiotherapy boost for dose escalation as a treatment option for high-grade spinal cord astrocytic tumor. J Neurooncol 2006; 78: 63-69.

9. Perez CA, Thorstad WL, authors. Perez and Brady's Principles and Practice of Radiation Oncology. 2013. 6th ed. Philadelphia: Lippincott Williams and Wilkins, Wolters Kluwer Business; 659-694.

10. Abdel-Wahab M, Etuk B, Palermo J, Shirato H, Kresl J, Yapicier O, et al. Spinal cord gliomas: A multi-institutional retrospective analysis. Int J Radiat Oncol Biol Phys 2006; 64: 1060-1071.

11. Shen CX, Wu JF, Zhao W, Cai ZW, Cai RZ, Chen CM. Primary spinal glioblastoma multiforme. A case report and review of the literature. Medicine (Baltimore) 2017; 96: e6634.

12. Morais N, Mascarenha L, Fernandes JPS, Silva A, Magalhaes Z, Costa JA. Primary spinal glioblastoma: A case report and review of the literature. Oncol Lett. 2013; 5: 992-996.

13. Varghese SS, Sebastian P, Joseph V, Chacko G, Backianathan S. An unusually long survival of a patient with glioblastoma of spinal cord: a case report. J Clin Diagn Res 2014; 8: QD01- 03.

14. Purkayastha A, Sharma N, Sridhar MS, Abhishek D.Intramedullary Glioblastoma Multiforme of Spine with Intracranial Supratentorial Metastasis: Progressive Disease with a Multifocal Picture.Asian J Neurosurg 2018; 13: 1209-1212.

15. Behmanesh B, Setzer M, Konczalla J, et al: Management of patients with primary intramedullary spinal cord glioblastoma. World Neurosurg 2017; 98: 198-202.

16. Tseng HM, Kuo LT, Lien HC, et al. Prolonged survival of a patient with cervical intramedullary glioblastoma multiforme treated with total resection, radiation therapy, and temozolomide. Anticancer Drugs 2010; 21: 963-967