Is It Worth Considering Multicentric High-Grade Glioma a Surgical Disease? Analysis of Our Clinical Experience and Literature Review
Introduction. The simultaneous presence of multiple foci of high-grade glioma is a rare condition with a poor prognosis. By definition, if an anatomical connection through white matter bundles cannot be hypothesized, multiple lesions are defined as multicentric glioma (MC); on the other hand, when t...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-10-01
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| Series: | Tomography |
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| Online Access: | https://www.mdpi.com/2379-139X/7/4/45 |
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| author | Francesco Guerrini Lucio Aniello Mazzeo Giorgio Rossi Mariarosaria Verlotta Mattia Del Maestro Angela Dele Rampini Alessandro Pesce Marco Viganò Sabino Luzzi Renato Juan Galzio Andrea Salmaggi Giannantonio Spena |
| author_facet | Francesco Guerrini Lucio Aniello Mazzeo Giorgio Rossi Mariarosaria Verlotta Mattia Del Maestro Angela Dele Rampini Alessandro Pesce Marco Viganò Sabino Luzzi Renato Juan Galzio Andrea Salmaggi Giannantonio Spena |
| author_sort | Francesco Guerrini |
| collection | DOAJ |
| description | Introduction. The simultaneous presence of multiple foci of high-grade glioma is a rare condition with a poor prognosis. By definition, if an anatomical connection through white matter bundles cannot be hypothesized, multiple lesions are defined as multicentric glioma (MC); on the other hand, when this connection exists, it is better defined as multifocal glioma (MF). Whether surgery can be advantageous for these patients has not been established yet. The aim of our study was to critically review our experience and to compare it to the existing literature. Materials and Methods. Retrospective analysis of patients operated on for MC HGG in two Italian institutions was performed. Distinction between MC and MF was achieved through revision of MR FLAIR images. Clinical and radiological preoperative and postoperative data were analyzed through chart revision and phone interviews. The same data were extracted from literature review. Univariate and multivariate analyses were conducted for the literature review only, and the null hypothesis was rejected for a <i>p</i>-value ≥ 0.05. Results. Sixteen patients met the inclusion criteria; male predominance and an average age of 66.5 years were detected. Sensory/motor deficit was the main onset symptom both in clinical study and literature review. A tendency to operate on the largest symptomatic lesion was reported and GTR was reached in the majority of cases. GBM was the histological diagnosis in most part of the patients. OS was 8.7 months in our series compared to 7.5 months from the literature review. Age ≤ 70 years, a postoperative KPS ≥ 70, a GTR/STR, a second surgery and adjuvant treatment were shown to be significantly associated with a better prognosis. Pathological examination revealed that MC HGG did not originate by LGG. Conclusions. MC gliomas are rare conditions with high malignancy and a poor prognosis. A maximal safe resection should be attempted whenever possible, especially in younger patients with life-threatening large mass. |
| first_indexed | 2024-03-10T03:58:55Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 2379-1381 2379-139X |
| language | English |
| last_indexed | 2024-03-10T03:58:55Z |
| publishDate | 2021-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Tomography |
| spelling | doaj.art-4ef8d49414064498b4dc193c1228edc02023-11-23T10:48:54ZengMDPI AGTomography2379-13812379-139X2021-10-017452353210.3390/tomography7040045Is It Worth Considering Multicentric High-Grade Glioma a Surgical Disease? Analysis of Our Clinical Experience and Literature ReviewFrancesco Guerrini0Lucio Aniello Mazzeo1Giorgio Rossi2Mariarosaria Verlotta3Mattia Del Maestro4Angela Dele Rampini5Alessandro Pesce6Marco Viganò7Sabino Luzzi8Renato Juan Galzio9Andrea Salmaggi10Giannantonio Spena11Unit of Neurosurgery, Department of Neurosciences, Hospital A. Manzoni, 23900 Lecco, ItalyUnit of Neurosurgery, Department of Neurosciences, Hospital A. Manzoni, 23900 Lecco, ItalyUnit of Pathology, Department of Oncology, Hospital A. Manzoni, 23900 Lecco, ItalyUnit of Neurosurgery, Department of Neurosciences, Hospital A. Manzoni, 23900 Lecco, ItalyUnit of Neurosurgery, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, ItalyUnit of Neurosurgery, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, ItalyUnit of Neurosurgery, Hospital S. M. Goretti, 04100 Latina, ItalyOrthopedic Biotechnology Lab, IRCCS Orthopedic Institute Galeazzi, 20161 Milan, ItalyUnit of Neurosurgery, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, ItalyUnit of Neurosurgery, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, ItalyUnit of Neurology, Department of Neurosciences, Hospital A. Manzoni, 23900 Lecco, ItalyUnit of Neurosurgery, Department of Neurosciences, Hospital A. Manzoni, 23900 Lecco, ItalyIntroduction. The simultaneous presence of multiple foci of high-grade glioma is a rare condition with a poor prognosis. By definition, if an anatomical connection through white matter bundles cannot be hypothesized, multiple lesions are defined as multicentric glioma (MC); on the other hand, when this connection exists, it is better defined as multifocal glioma (MF). Whether surgery can be advantageous for these patients has not been established yet. The aim of our study was to critically review our experience and to compare it to the existing literature. Materials and Methods. Retrospective analysis of patients operated on for MC HGG in two Italian institutions was performed. Distinction between MC and MF was achieved through revision of MR FLAIR images. Clinical and radiological preoperative and postoperative data were analyzed through chart revision and phone interviews. The same data were extracted from literature review. Univariate and multivariate analyses were conducted for the literature review only, and the null hypothesis was rejected for a <i>p</i>-value ≥ 0.05. Results. Sixteen patients met the inclusion criteria; male predominance and an average age of 66.5 years were detected. Sensory/motor deficit was the main onset symptom both in clinical study and literature review. A tendency to operate on the largest symptomatic lesion was reported and GTR was reached in the majority of cases. GBM was the histological diagnosis in most part of the patients. OS was 8.7 months in our series compared to 7.5 months from the literature review. Age ≤ 70 years, a postoperative KPS ≥ 70, a GTR/STR, a second surgery and adjuvant treatment were shown to be significantly associated with a better prognosis. Pathological examination revealed that MC HGG did not originate by LGG. Conclusions. MC gliomas are rare conditions with high malignancy and a poor prognosis. A maximal safe resection should be attempted whenever possible, especially in younger patients with life-threatening large mass.https://www.mdpi.com/2379-139X/7/4/45glioblastomaMRImultifocalbraintumor |
| spellingShingle | Francesco Guerrini Lucio Aniello Mazzeo Giorgio Rossi Mariarosaria Verlotta Mattia Del Maestro Angela Dele Rampini Alessandro Pesce Marco Viganò Sabino Luzzi Renato Juan Galzio Andrea Salmaggi Giannantonio Spena Is It Worth Considering Multicentric High-Grade Glioma a Surgical Disease? Analysis of Our Clinical Experience and Literature Review Tomography glioblastoma MRI multifocal brain tumor |
| title | Is It Worth Considering Multicentric High-Grade Glioma a Surgical Disease? Analysis of Our Clinical Experience and Literature Review |
| title_full | Is It Worth Considering Multicentric High-Grade Glioma a Surgical Disease? Analysis of Our Clinical Experience and Literature Review |
| title_fullStr | Is It Worth Considering Multicentric High-Grade Glioma a Surgical Disease? Analysis of Our Clinical Experience and Literature Review |
| title_full_unstemmed | Is It Worth Considering Multicentric High-Grade Glioma a Surgical Disease? Analysis of Our Clinical Experience and Literature Review |
| title_short | Is It Worth Considering Multicentric High-Grade Glioma a Surgical Disease? Analysis of Our Clinical Experience and Literature Review |
| title_sort | is it worth considering multicentric high grade glioma a surgical disease analysis of our clinical experience and literature review |
| topic | glioblastoma MRI multifocal brain tumor |
| url | https://www.mdpi.com/2379-139X/7/4/45 |
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