Optic Nerve and Visual Pathways Primary Glioblastoma Treated with Radiotherapy and Temozolomide Chemotherapy

Caignard, Angélique; Faguer, R.; Mercier, Philippe; Menei, Philippe; Miléa, Dan

doi:10.5301/ejo.5000416

Cited by 6 publications

(3 citation statements)

References 6 publications

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“…[ 1 4 ] Standard treatment of GBM in most cases includes combined chemoradiation therapy. [ 3 ] There are some alternative medical approaches specifically for optic GBM, such as medically induced hypothyroidism with carboplatin, which was seen in the Ashur-Fabian et al . study, however, none of these therapies have become standard treatment.…”

Section: Discussionmentioning

confidence: 99%

Glioblastoma multiforme of the optic chiasm: A rare case of common pathology

Lyapichev¹,

Bregy²,

Cassel³

et al. 2016

Surg Neurol Int

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Background:Malignant optic and chiasmatic gliomas are extremely rare, and are classified pathologically as anaplastic astrocytoma or glioblastoma multiforme (GBM). Approximately 40 cases of optic GBM in adults have been reported in the literature, and only five of them were described to originate from the optic chiasm.Case Description:An 82-year-old male patient with a past medical history of diabetes mellitus type 2, melanoma, and bladder cancer presented with gradual vision loss of the left eye in a period of 1 month. After neuro-ophthalmological examination, the decision of thither magnetic resonance imaging (MRI) studies was made. It showed a contrast enhancing mass in the region of the optic chiasm. In this case, imaging study was not enough to establish an accurate diagnosis and a left pterional craniotomy for biopsy and resection of the optic chiasmal mass was performed. After histological evaluation of the mass tissue, the diagnosis of GBM was made. Taking into account the patient's poor condition and unfavorable prognosis he was moved to inpatient hospice. The patient deceased within 2 months after surgery.Conclusion:Chiasmal GBM is an extremely rare condition where a biopsy is necessary for accurate diagnosis and optimal treatment. Differential diagnosis for such lesions can be very difficult and include demyelinating optic neuritis and non-demyelinating inflammatory optic neuropathy (e.g., sarcoid), vascular lesions (e.g., cavernoma), compressive lesions of the optic apparatus, metastatic malignancy, and primary tumors of the anterior optic pathway. The role of chemotherapy and radiotherapy including novel stereotaxic radiosurgery methods is still unclear and will need to be evaluated.

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Section: Discussionmentioning

confidence: 99%

Glioblastoma multiforme of the optic chiasm: A rare case of common pathology

Lyapichev¹,

Bregy²,

Cassel³

et al. 2016

Surg Neurol Int

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“…35,37 Among these, 32 were confirmed to be glioblastomas, with a mean patient age of 62 years at the time of diagnosis. 2,4,7,[10][11][12][13]25,27,28,30,34,35,37,39 Fourteen of the patients were female (44%) and 18 were male (56%). The median overall survival of the reported cases of optic nerve glioblastoma was 7 months (Table 1).…”

Section: Discussionmentioning

confidence: 99%

“…Among the reported optic nerve glioblastoma cases, 5 presented with extensive involvement of contiguous structures (16%), 14,15,23,35 and 5 were a part of multifocal glioblastoma. 1,24,35 The diagnosis of optic nerve glioblastoma can be challenging, 28 since initial neuroimaging may demonstrate an edematous, thickened optic nerve; 9,19,21 anterior optic tract contrast enhancement; 4,28 an enhancing space-occupying cystic 5 or solid lesion; 3,7 or multifocal enhancing lesions with optic nerve involvement. 1,24 Considering that optic nerve glioblastoma is a rare entity, the differential diagnosis in patients suspected of harboring these lesions should remain broad.…”

Section: Discussionmentioning

confidence: 99%

Transtentorial dissemination of optic nerve glioblastoma: case report

Mastorakos

Hays

Caruso

et al. 2018

Journal of Neurosurgery

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Optic nerve glioblastoma is a rare entity that usually presents with rapidly progressive vision loss, which eventually results in blindness and, ultimately, death. As with malignant gliomas in other anatomical locations, local recurrence is common. Isolated rapid changes in vision, atypical neuroimaging findings, and the rarity of optic nerve glioblastoma may render diagnosis challenging and, thus, delay treatment. The authors present a case of optic nerve glioblastoma that was treated with subtotal resection followed by adjuvant radiation therapy and temozolomide. One year following the initial diagnosis, the patient developed a right cerebellar lesion, which was histopathologically consistent with glioblastoma. This case represents the first report of transtentorial dissemination of an optic nerve glioblastoma. In addition, the authors reviewed the literature regarding optic nerve glioblastomas. Of the 73 previously reported cases of malignant optic nerve gliomas, 32 were histologically confirmed glioblastomas. The mean age at diagnosis was 62 years, and 56% were male; the median survival was 7 months. A malignant glioma of the optic nerve should be considered in the differential diagnosis of a patient with rapidly progressive visual loss. However, the incidence of optic nerve glioblastoma is exceedingly low.

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Primary glioblastoma multiform (GBM) of the optic nerve and chiasma: A case report and systematic review of the literature

Mulhem

2024

Clinical Case Reports

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Key Clinical MessagePrimary GBM of the optic nerve and chiasma should be included in the differential diagnosis of progressive lesions despite initial treatment; clinicians should avoid delay in confirming the histology to initiate proper treatment and improve prognosis.AbstractPrimary GBM of the optic nerve or chiasma is very rare. The characteristics of this condition have not been well‐described, which poses difficulties in establishing the correct diagnosis, affecting the treatment and the prognosis. We present a case of GBM of the optic chiasma diagnosed through an open biopsy at our centre. Following the PRISMA statement, we also conducted a systematic review after protocol registration in PROSPERO (CRD42021285855). We searched Medline and Embase through Ovid from inception until December 31, 2021. Two reviewers independently screened the studies. Studies were eligible for inclusion if they reported cases of primary GBM confined to the optic nerve or chiasma as the initial radiological diagnosis. A 77‐year‐old female was referred for progressive visual loss lasting 8 weeks. MRI revealed a suspected lesion in the left chiasma. The patient's vision deteriorated further despite initially diagnosing an inflammatory process and empirical treatment with corticosteroids. Subsequently, the patient underwent an open biopsy and surgical debulking. Histology, including epigenetic analysis, confirmed GBM grade IV. Radiochemotherapy was administered. The patient died 19 months after surgery. We identified 45 similar cases (22 female) reported in 35 studies between 1949 and 2020. The mean age of the cases was 61 (SD = 14.6). Most cases were misdiagnosed and mistreated accordingly, so there was a median delay of 8 weeks (IQR: 5–14 weeks) in obtaining histological confirmation of the diagnosis, delaying the initiation of appropriate treatment. Five cases became no treatment since the patients died shortly after the delayed histologic diagnosis. The Kaplan–Meier estimate indicated that most patients died within 20 months of presentation, with a 1‐year survival rate of 50%, and untreated cases had very low survival rates compared to treated cases. Primary GBM of the optic nerve and chiasma is a rare condition primarily affecting adults. The rarity of this condition contributes to initial misdiagnosis, mistreatment, and delays in confirming the histology and initiating appropriate treatment. The prognosis remains poor, but treatment, including surgery and radiochemotherapy, improves survival.

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Optic Nerve and Visual Pathways Primary Glioblastoma Treated with Radiotherapy and Temozolomide Chemotherapy

Abstract: Combined radiotherapy and temozolomide may be an alternative treatment in optic nerve and visual pathways primary GBM, potentially providing a longer survival.

Cited by 6 publications

References 6 publications

Glioblastoma multiforme of the optic chiasm: A rare case of common pathology

Glioblastoma multiforme of the optic chiasm: A rare case of common pathology

Transtentorial dissemination of optic nerve glioblastoma: case report

Primary glioblastoma multiform (GBM) of the optic nerve and chiasma: A case report and systematic review of the literature

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