Steinmetz M P, Barnett G H, Kim B S, Chidel M A, Suh J H
Department of Neurosurgery, Brain Tumor and Neuro-Oncology Center, The Cleveland Clinic, OH 44195, USA.
J Neurooncol. 2001 Dec;55(3):167-71. doi: 10.1023/a:1013873431159.
The first case was recently reported of tumor seeding by glioblastoma multiforme (GBM) after stereotactic biopsy. This occurred despite radiosurgical treatment of the lesion post-biopsy. We report the first case of metastatic seeding along the needle biopsy tract of a GBM in which the tract was within the treatment field of subsequent fractionated radiation therapy.
A 56-year-old man presented with left-sided focal motor seizures. An MRI showed an enhancing right cingulate gyrus lesion.
A stereotactic biopsy of the lesion disclosed GBM. Radiation therapy was begun 25 days after biopsy and was completed 39 days thereafter. The biopsy tract received a minimum of 60 Gy. Subsequent magnetic resonance scanning showed the lesion to have doubled in size and evidence of enhancement along the biopsy tract. At surgery, specimens obtained from the biopsy tract, as determined using surgical navigation, revealed GBM.
Seeding of the biopsy tract, radioresistance and the time interval until radiotherapy are the most likely explanations for tumor growth along the biopsy tract in this case. Consideration should be given for an early start to radiotherapy among those who undergo stereotactic biopsy for GBM. Further research will allow one to determine the radiosensitivity of these tumors and determine which patients may benefit from a radiosurgical or fractionated radiotherapy boost to the biopsy tract.
最近报道了首例多形性胶质母细胞瘤（GBM）在立体定向活检后出现肿瘤播散的病例。尽管活检后对病变进行了放射外科治疗，但仍发生了这种情况。我们报告了首例GBM沿针吸活检通道发生转移播散的病例，其中该通道位于后续分次放射治疗的照射野内。
一名56岁男性出现左侧局灶性运动性癫痫发作。磁共振成像（MRI）显示右侧扣带回有强化病变。
对该病变进行立体定向活检，结果显示为GBM。活检后25天开始放疗，39天后完成。活检通道至少接受了60 Gy的照射。随后的磁共振扫描显示病变大小翻倍，且活检通道有强化迹象。手术时，通过手术导航确定从活检通道获取的标本显示为GBM。
活检通道播散、放射抗性以及放疗开始的时间间隔最有可能解释该病例中沿活检通道的肿瘤生长情况。对于接受GBM立体定向活检的患者，应考虑尽早开始放疗。进一步的研究将有助于确定这些肿瘤的放射敏感性，并确定哪些患者可能从对活检通道的放射外科或分次放疗加量中获益。
