Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK.
Maurice Wohl institute, Kings College London, London, UK.
Neurosurg Rev. 2023 Sep 4;46(1):223. doi: 10.1007/s10143-023-02126-w.
Butterfly glioblastomas (bGBM) are a rare subset of WHO grade IV tumours that carry a poor prognosis with a median survival ranging between 3.3 to 6 months. Given their poor prognosis, there is debate over whether histological diagnosis with a biopsy or any surgical or oncological intervention alters disease progression. With this in mind, we reviewed our experience as a high-volume unit to evaluate management decisions and outcomes. A retrospective analysis was undertaken (January 2009 to June 2021) of the electronic patient records of a large neurosurgical centre. We assessed patient demographics, initial clinical presentation, tumour characteristics, clinical management and overall survival (Kaplan-Meier estimator, log-rank analysis and cox proportional hazard analysis). Eighty cases of bGBM were identified. These patients were managed with biopsy ± adjuvant therapy (36), with radiotherapy alone without biopsy (3), or through surgical resection (3). Thirty-eight cases of suspected bGBM were managed conservatively, receiving no oncological treatment or surgical resection/biopsy for histological diagnosis. Those managed conservatively and with radiotherapy without biopsy were diagnosed at neuro-oncology multidisciplinary meeting (MDT) based on clinical presentation and radiological imaging. No significant difference in survival was seen between conservative management compared with single adjuvant treatment (p = 0.69). However, survival was significantly increased when patients received dual adjuvant chemoradiotherapy following biopsy or resection (p = 0.002). A Cox Proportional Hazards model found that survival was significantly impacted by the oncology treatment (p < 0.001), but was not significantly related to potential confounding variables such as the patient's age (p = 0.887) or KPS (p = 0.057). Butterfly glioblastoma have a poor prognosis. Our study would suggest that unless a patient is planned for adjuvant chemoradiotherapy following biopsy, they should be managed conservatively. This avoids unnecessary procedural interventions with the associated morbidities and costs.
蝶形胶质母细胞瘤（bGBM）是一种罕见的 WHO 四级肿瘤亚型，预后较差，中位生存期为 3.3 至 6 个月。鉴于其预后较差，对于活检或任何手术或肿瘤学干预是否改变疾病进展存在争议。考虑到这一点，我们回顾了我们作为一个高容量单位的经验，以评估管理决策和结果。对一家大型神经外科中心的电子患者记录进行了回顾性分析（2009 年 1 月至 2021 年 6 月）。我们评估了患者的人口统计学特征、初始临床表现、肿瘤特征、临床管理和总生存期（Kaplan-Meier 估计、对数秩分析和 Cox 比例风险分析）。共确定了 80 例 bGBM 病例。这些患者的治疗方法包括活检+辅助治疗（36 例）、单独放疗而不进行活检（3 例）或手术切除（3 例）。38 例疑似 bGBM 的患者接受了保守治疗，未接受肿瘤治疗或手术切除/活检进行组织学诊断。在神经肿瘤多学科会议（MDT）上根据临床表现和影像学诊断，对接受保守治疗和未进行活检的单纯放疗的患者进行了诊断。与单一辅助治疗相比，保守治疗的患者之间的生存无显著差异（p=0.69）。然而，在活检或切除后接受双辅助放化疗的患者的生存率显著提高（p=0.002）。Cox 比例风险模型发现，生存受肿瘤治疗的显著影响（p<0.001），但与患者年龄（p=0.887）或 KPS（p=0.057）等潜在混杂变量无显著关系。蝴蝶形胶质母细胞瘤的预后较差。我们的研究表明，除非患者计划在活检后接受辅助放化疗，否则应进行保守治疗。这可以避免不必要的程序干预及其相关的发病率和成本。
