Abstract
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 p-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.
Highlights
The simultaneous presence of multiple foci of high-grade glioma is a rare condition with a poor prognosis
Mutated Glioblastoma Multiforme (GBM) shows a longer history and a better therapeutic response that confers a greater overall survival compared to the IDH wild type GBM [2,3,4]
Multiple neoplastic brain lesions are typical of secondary metastatic disease, the simultaneous presence of two or more lesions has been described in around 2% to 9%
Summary
The simultaneous presence of multiple foci of high-grade glioma is a rare condition with a poor prognosis. 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). If the origin of multiple lesions in different lobes or/and hemispheres cannot be ascribed to predictable routes, a MC glioma is more likely [5]. This latter is a rare entity with a worse prognosis compared to unifocal HGG and a clear therapeutic strategy has not been established yet. In some selected cases, where one lesion presents a larger volume or is clearly symptomatic, not life threatening, surgical resection can be indicated in order to reduce the mass effect and establish a correct histological and molecular diagnosis
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
