Carvalho Juliana Arcangelo Di Vita, Barbosa Caroline Chaul de Lima, Feher Olavo, Maldaun Marcos Vinicius Calfat, Camargo Veridiana Pires de, Moraes Fabio Y, Marta Gustavo Nader
Department of Radiation Oncology - Oncologia Centenário São Leopoldo - Rio Grande do Sul, Brasil.
Department of Radiology and Oncology - Clinical Oncology Unit; Faculdade de Medicina da Universidade de São Paulo - Instituto do Câncer do Estado de São Paulo (Icesp); Sao Paulo, Brasil.
Rev Assoc Med Bras (1992). 2019 Mar;65(3):460-468. doi: 10.1590/1806-9282.65.3.460. Epub 2019 Apr 11.
Glioblastoma (GBM) is the most frequent primary malignant tumor from the central nervous system in adults. However, the presence of systemic metastasis is an extremely rare event. The objective of this study was to review the literature, evaluating the possible biological mechanisms related to the occurrence of systemic metastasis in patients diagnosed with GBM.
The mechanisms that may be related to GBM systemic dissemination are the blood-brain barrier breach, often seen in GBM cases, by the tumor itself or by surgical procedures, gaining access to blood and lymphatic vessels, associated with the acquisition of mesenchymal features of invasiveness, resistance to the immune mechanisms of defense and hostile environment through quiescence.
Tumor cells must overcome many obstacles until the development of systemic metastasis. The physiologic mechanisms are not completely clear. Although not fully understood, the pathophysiological understanding of the mechanisms that may be associated with the systemic spread is salutary for a global understanding of the disease. In addition, this knowledge may be used as a basis for a therapy to be performed in patients diagnosed with GBM distant metastasis.
胶质母细胞瘤（GBM）是成人中枢神经系统中最常见的原发性恶性肿瘤。然而，发生全身转移的情况极为罕见。本研究的目的是回顾文献，评估与诊断为GBM的患者发生全身转移相关的可能生物学机制。
可能与GBM全身播散相关的机制是血脑屏障破坏，这在GBM病例中经常可见，可由肿瘤本身或手术操作导致，使肿瘤细胞进入血液和淋巴管，同时伴随着获得间充质侵袭性特征、对免疫防御机制的抗性以及通过静止适应恶劣环境。
肿瘤细胞在发生全身转移之前必须克服许多障碍。其生理机制尚不完全清楚。尽管尚未完全理解，但对可能与全身扩散相关机制的病理生理学认识有助于全面了解该疾病。此外，这一知识可作为对诊断为GBM远处转移患者进行治疗的基础。
