An Unusually Long Survival of A Patient with Glioblastoma of Spinal Cord: A Case Report

Abstract

A 22-year-old gentleman presented in December 2006 with a short one-month history of progressive weakness of bilateral lower limbs, decreased sensation below the mid chest level, urinary hesitancy with a sense of incomplete evacuation of the bladder. On examination, the tone was spastic in both lower limbs with power of grade 0 and absence of all modalities of sensation below T4 level bilaterally. MRI spine showed a diffuse contrast enhancing intramedullary mass from D3 to D6 level [ Fig-5a and 5b]. The MIB-1 labelling index was 10% [Table/ Fig-6]. Despite the absence of necrosis, a diagnosis of Glioblastoma was considered owing to the presence of microvascular proliferation.Postoperatively, he was treated with conventional radiation therapy, 5040 cGy in 28 fractions, five fractions per week. Physiotherapy and occupational therapy were continued and he had neurological improvement with grade 4 power in right lower limb, left thigh and knee, and grade 2 powers in left ankle dorsiflexion. Sensation recovered completely. He was able to void normally at this time.[Table/ Fig-7] shows the imaging at the follow up visit in May 2008.In April 2012, he presented with increased low backache and tightness of left lower limb of one month duration with reduction in power in the left lower limb to grade 2. There was decreased sensation along the L3 to L5 dermatomes. MRI spine showed recurrent contrast enhancing lesions in mulltiple levels, largest lesion at L1/L2 levels and L5 levels [Table/ Fig-8]. He received radiotherapy to the lumbar lesion -50 Gy in 25 fractions by three dimensional conformal techniques. The power in left lower limb improved to grade 4, and he was able to carry out activities of daily living without support.In July 2013, he developed giddiness and vomiting with postural imbalance of one month duration and was found to have a left cerebellopontine (CP) angle tumour with infiltration of the cerebellum, midbrain and pons [Table/ Fig-9]. He received palliative radiotherapy to whole brain, 36 Gy in 12 fractions using conventional technique. He was also started on chemotherapy with Temozolomide (TMZ). He is alive continuing chemotherapy currently at the point of reporting this case with good quality of life and abilities to do activities of daily living but with residual minimal incoordination. Oncology Section aBstRaCtPrimary glioblastoma of spinal cord are rare and are associated with poor survival especially in adults. We report a case of glioblastoma of thoracic spinal cord (D3 to D6) in an adult treated with partial resection surgery and radiation therapy with a survival of six years with good quality of life. The patient had paraplegia at presentation but improved after surgery and radiation therapy to grade 4 in both lower limbs. After 5 years, he developed new lesion in a different location of the spine (L1, L2 & L5) along with multiple lesions over entire spine and was treated with radiation therapy and a year later developed a new lesion intracranially in the posterior fossa involving cerebelloponti...