Abstract
Glioblastoma (GBM) is the most common primary malignant tumor in the central nervous system and some GBMs present as multiple lesions (M-GBM), posing challenges and poorer outcomes. The absence of clear guidelines for radiotherapy and chemotherapy after biopsy or resection further complicates treatment decisions. The aim of this retrospective single-institutional study is to compare the overall survival (OS), progression-free survival (PFS), and the impact of prognostic markers in unifocal and multifocal IDH wild-type glioblastomas. The study involved 177 GBM patients diagnosed between 2015 and 2022. From this group, 101 patients with confirmed IDH wild-type GBM were selected to assess the impact of lesion focalities on prognosis. The median patient age was 60, comprising 37% females and 63% males. Positive P53 expression was seen in 65 patients. Surgical procedures included gross total resection (GTR) or subtotal resection (STR) for 66%. Radiation therapy employed the IMRT technique, combined with concurrent TMZ treatment. Adjuvant therapy referral was arranged for 68 patients. In this study, we examined 101 IDH wild-type glioblastoma patients, of whom 78 had unifocal and 23 had multifocal tumors. Surgical approaches included GTR (13%), STR (53%), and biopsy (34%). All patients received TMZ with RT. Progression occurred in 49%-38 unifocal, 11 multifocal cases. PFS analysis showed no significant difference between unifocal and multifocal patients. OS analysis also showed no significant difference. Univariate analysis revealed PFS factors: focalization, p53 expression, hypofractionated RT (HRT). For OS, adjuvant TMZ usage was influential. Extent of resection impacted OS-STR had a 3.47-fold higher risk than GTR. This study sheds light on the management of multifocal glioblastoma, providing insights into treatment strategies and survival outcomes. Despite challenges, optimal management approaches are crucial for improving patient prognosis and quality of life.
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