Therapeutic approach in glioblastoma multiforme with primitive neuroectodermal tumor components: Case report and review of the literature

Prelaj,Arsela; Rebuzzi,Sara  Elena; Caffarena,Giovanni; Giròn Berrìos,Julio  Rodrigo; Pecorari,Silvia; Fusto,Carmela; Caporlingua,Alessandro; Caporlingua,Federico; Di Palma,Annamaria; Magliocca,Fabio  Massimo; Salvati,Maurizio; Tomao,Silverio; Bianco,Vincenzo

doi:10.3892/ol.2018.8102

Therapeutic approach in glioblastoma multiforme with primitive neuroectodermal tumor components: Case report and review of the literature

Authors:
- Arsela Prelaj
- Sara Elena Rebuzzi
- Giovanni Caffarena
- Julio Rodrigo Giròn Berrìos
- Silvia Pecorari
- Carmela Fusto
- Alessandro Caporlingua
- Federico Caporlingua
- Annamaria Di Palma
- Fabio Massimo Magliocca
- Maurizio Salvati
- Silverio Tomao
- Vincenzo Bianco
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Affiliations: Department of Medical Oncology Unit A, Policlinico Umberto I, ‘Sapienza’ University of Rome, I‑00161 Rome, Italy, Department of Medical Oncology Unit 1, IRCCS AOU San Martino‑IST, I‑16132 Genoa, Italy, Department of Neurosurgery, IRCCS AOU San Martino‑IST, I‑16132 Genoa, Italy, Department of Neurology and Psychiatry, Neurosurgery, Policlinico Umberto I, ‘Sapienza’ University of Rome, I‑00161 Rome, Italy, Department of Radiotherapy, San Pietro Hospital, Fatebenefratelli, I‑00189 Rome, Italy, Department of Gynecology, Obstetrics and Urology, Umberto I, ‘Sapienza’ University of Rome, I‑00161 Rome, Italy, Department of Neurosurgery, IRCCS Neuromed, I‑86077 Pozzilli, Italy, Department of Radiological Sciences, Oncology and Pathology, ‘Sapienza’ University of Rome, I‑04100 Latina, Italy
Published online on: February 21, 2018 https://doi.org/10.3892/ol.2018.8102
Pages: 6641-6647

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Abstract

Glioblastoma multiforme (GBM) is the most common and aggressive malignant glioma that is treated with first-line therapy, using surgical resection followed by local radiotherapy and concomitant/adjuvant temozolomide (TMZ) treatment. GBM is characterised by a high local recurrence rate and a low response to therapy. Primitive neuroectodermal tumour (PNET) of the brain revealed a low local recurrence rate; however, it also exhibited a high risk of cerebrospinal fluid (CSF) dissemination. PNET is treated with surgery followed by craniospinal irradiation (CSI) and platinum-based chemotherapy in order to prevent CSF dissemination. GBM with PNET-like components (GBM/PNET) is an emerging variant of GBM, characterised by a PNET‑like clinical behaviour with an increased risk of CSF dissemination; it also may beneﬁt from platinum‑based chemotherapy upfront or following failure of GBM therapy. The results presented regarding the management of GBM/PNET are based on case reports or case series, so a standard therapeutic approach for GBM/PNET is not defined, constituing a challenging diagnostic and therapeutic dilemma. In this report, a case of a recurrent GBM/PNET treated with surgical resection and radiochemotherapy as Stupp protocol, and successive platinum-based chemotherapy due to the development of leptomeningeal dissemintation and an extracranial metastasis, is discussed. A review of the main papers regarding this rare GBM variant and its therapeutic approach are also reported. In conclusion, GBM/PNET should be treated with a multimodal approach including surgery, chemoradiotherapy, and/or the early introduction of CSI and platinum‑based chemotherapy upfront or at recurrence.

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