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Abstract
Glioblastoma multiforme (GBM) is the most malignant primary brain tumor. Conventional therapies are considered palliative and long-term progression-free survival remains low for most GBM patients even after surgical excision, concomitant radiotherapy and/or chemotherapy with nitrosoureas or Temozolomide. We report the case of a 47-year-old man who presented worsening headache over a month, accompanied by episodes of morning vomiting and hyposthenia of the left hemisoma. Cerebral tomographic scan revealed an expansive process on the right frontal site. Following surgical resection, the patient was diagnosed with diffusely infiltrating GBM. After surgery, the patient underwent radiotherapy and chemotherapy with Temozolomide for 6 months. Eleven months later, the patient underwent a second-look surgery with excision of a new right superior frontal nodule. This time the patient refused both radio and chemotherapy and underwent follow-up only. After 12 months he underwent a new craniotomy for the excision of a third GBM relapse. Following resection, the patient agreed to be treated for 6 months with fotemustine (FTM) 100 mg/m2 intravenously every 4 weeks as chemotherapy. After 3 months of treatment the patient underwent a full physical examination and diagnostic monitoring of the tumor using Magnetic Resonance Imaging (MRI) of the brain and whole body Computerised Tomography (CT). During FTM treatment, the most frequent, but reversible toxic effect was hematological grade 2 anemia and thrombocytopenia but no other grade >2 toxicity was recorded, so there was no reduction or delay in treatment. Presently, after 8 years of follow-up, the patient is in excellent health and has no evidence of intracranial disease recurrence. In light of this case, post-surgical FTM treatment seems to represent an interesting well-tolerated treatment possibility in patients with recurrent malignant GBM of the brain, given that there are very few reports of such a remission in the literature.
Highlights
Conventional therapies are considered palliative and long-term progression-free survival remains low for most Glioblastoma multiforme (GBM) patients even after surgical excision, concomitant radiotherapy and/or chemotherapy with nitrosoureas or Temozolomide
Meningiomas, glioblastomas and astrocytomas constitute over half of all central nervous system (CNS) tumors
The treatment of GBM is still a challenge, and despite first-line therapy consisting of surgery, radiotherapy and TMZ as adjuvant chemotherapy, the tumor invariably recurs, allowing median survival of only 9 - 12 months [9]
Summary
Meningiomas, glioblastomas and astrocytomas constitute over half of all central nervous system (CNS) tumors. Glioblastoma multiforme is a highly malignant astrocytic tumor that accounts for 80% of all the malignant gliomas It is a neoplasm occurring mainly in adult age with peak incidence in individuals between 60 and 70 years of age, with prevalence in males [1]. The problem of unsatisfactory local control of recurrence continues to exist Such a dismal prognosis is mainly due to the rapid onset of radio- and/or chemoresistance as well as to the limited therapeutic options available for GBM recurring after standard treatment. Recent clinical studies have shown that fotemustine (FTM) seems to represent an interesting well-tolerated treatment possibility in pretreated patients with recurrent malignant GBM [7,8,9]. In this study we used magnetic resonance imaging (MRI) to describe the response of a 47-year-old male with GBM, who had been pretreated and suffered a third relapse who was treated for 6 months with FTM
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