Impact of adjuvant chemotherapy for gliomatosis cerebri

Abstract

BackgroundGliomatosis cerebri (GC) is characterized by a diffuse infiltration of tumor cells throughout CNS, however, few details are available about the chemotherapeutic effect on GC. The aim of this study was to investigate its clinical course and to determine the efficacy of chemotherapy for GC.MethodsBetween Jan. 1999 and Dec. 2004, 37 GC patients were diagnosed by biopsy and treated with radiotherapy in a single institution. To determine the efficacy of chemotherapy for GC, we retrospectively reviewed their clinical courses. The study cohort was divided into 2 groups, those with and without receiving post-radiotherapy adjuvant chemotherapy such as temozolomide or nitrosourea-based chemotherapy.ResultsNineteen patients with adjuvant chemotherapy were assigned to the chemotreatment group and 18 with radiotherapy alone were assigned to the control group. Mean survival for chemotreatment group and control group were 24.2 and 13.1 months, respectively (p = 0.045). Time to progression for these groups were 16.0 and 6.0 months, respectively (p = 0.007). Overall review of the clinical course of patients with GC provided that early appearance of new contrast-enhancing lesions within 6 months from the initial diagnosis and higher histological grade were closely associated with poor survival (p < 0.001 and p = 0.008).ConclusionAdjuvant chemotherapy following radiotherapy could prolong the survival in patients with GC. In addition, newly developed contrast-enhanced lesions on the follow-up MR images indicate the progression of GC.

Clinical relevance of molecular subgrouping of gliomatosis cerebri per 2016 WHO classification: a clinicopathological study of 89 cases

“…Galectin-3 expression in glial tumor cells has been reported to be related to infiltrative cell motility away from hypoxic regions (27). Our molecular and immunohistochemical observations are interesting in the context of previously published data, as GC has been considered a lesion of intermediate malignancy in the progression of diffuse glioma to GBMs, and the progression of GC is mediated by tumor stem cells (20). As GC shares characteristics with neural stem cells, GC may show migratory behavior, diversity of progeny and proliferative potential (20).…”

“…Our molecular and immunohistochemical observations are interesting in the context of previously published data, as GC has been considered a lesion of intermediate malignancy in the progression of diffuse glioma to GBMs, and the progression of GC is mediated by tumor stem cells . As GC shares characteristics with neural stem cells, GC may show migratory behavior, diversity of progeny and proliferative potential . Herrlinger et al have shown that 52.2% GCs show GBM‐IDHwt‐associated methylation profile, suggesting a close relationship between GC and GBM at the molecular level.…”

Gliomatosis cerebri: clinical characteristics, management, and outcomes

“…In the future, more data about patients who received concurrent radiation/temozolomide followed by adjuvant temozolomide (as is now standard for glioblastoma multiforme [12]) may become available. Others have reported benefit for chemotherapy in gliomatosis, including temozolomide [42-46] and nitrosoureas (especially for tumors with an oligodendroglial component) [47]. Thus, our series does not definitively rule out a role for chemotherapy in gliomatosis cerebri.…”

Gliomatosis cerebri: A consensus summary report from the First International Gliomatosis cerebri Group Meeting, March 26–27, 2015, Paris, France

“…Therefore, there is no consensus on the best approach for affected patients. In fact, there was no agreement among experts present in Paris about the real impact that chemotherapy or radiotherapy may have on this disease …”

“…In fact, there was no agreement among experts present in Paris about the real impact that chemotherapy or radiotherapy may have on this disease. [23][24][25][26][27] After confirming the diagnosis of GC based on imaging and histologic review, the panel of experts recommended the administration of upfront "institutional" chemotherapy used for HGG. Even though a few trials have attempted to establish the best chemotherapy approach for GC, there is insufficient data to recommend a specific combination.…”