Mikobi Emmanuel K, Voorhees Gerard, Mahmood Aftab, Gandhi Arpit, Bailey Michael, Phillips Jacqueline
Internal Medicine, Corpus Christi Medical Center, Corpus Christi, USA.
Radiation Oncology, Corpus Christi Medical Center, Corpus Christi, USA.
Cureus. 2023 Nov 26;15(11):e49441. doi: 10.7759/cureus.49441. eCollection 2023 Nov.
We present a 31-year-old female patient with primary glioblastoma multiforme (GBM) of the thoracic spine, diagnosed in approximately mid-2020. Her symptoms began several months prior with right foot paresthesia, which progressed to neuropathy ascending from her distal to proximal right lower extremity. Over several months, she developed lumbo-thoracic throbbing pain, which was dermatomal radiating anteriorly. Her pain worsened with activity. A thoracic spine MRI showed a focus of abnormal intradural intramedullary enhancement present from the T10-T11 disc level to the T12-L1 disc level, producing a large amount of edema within the cord. She underwent a gross total surgical resection. The patient had WHO Grade IV spinal GBM per histopathology. The patient received adjuvant concurrent radiation therapy and temozolomide chemotherapy. She continues with maintenance temozolomide along with the compassionate use of Novocure alternating electrical field therapy for the spine. She is being monitored closely by a multi-specialty team. At 32 months post-radiation therapy, her disease is stable with no evidence of progression. She has made significant improvements in her ambulation and symptoms. While GBM is most commonly intracranial, primary spinal GBM is relatively rare. Although established treatment guidelines exist for supratentorial GBM, treatment protocol choices for spinal GBM remain controversial but typically mirror those used for intracranial GBM and include surgery, radiation therapy, and chemotherapy. Alternating electrical field therapy, also known as tumor-treating fields (TTFields), is indicated for adjuvant treatment of intracranial GBM. While further studies of TTFields in spinal GBM are needed, TTFields appear to be a safe adjunct treatment for spinal GBM. Further studies are still needed aimed at finding an improved treatment for spinal GBM.
我们报告一名31岁的女性患者，患有胸椎原发性多形性胶质母细胞瘤（GBM），于2020年年中左右确诊。她的症状在数月前开始，表现为右脚感觉异常，随后发展为从右下肢远端向近端蔓延的神经病变。几个月后，她出现腰胸部搏动性疼痛，呈皮节分布并向前放射。活动时疼痛加剧。胸椎MRI显示，从T10 - T11椎间盘水平至T12 - L1椎间盘水平存在硬膜内髓内异常强化灶，脊髓内出现大量水肿。她接受了肿瘤全切手术。根据组织病理学检查，该患者的脊髓GBM为世界卫生组织IV级。患者接受了辅助同步放疗和替莫唑胺化疗。她继续接受替莫唑胺维持治疗，并在同情用药的情况下接受了用于脊柱的诺沃克鲁（Novocure）交变电场治疗。一个多专业团队对她进行密切监测。放疗后32个月，她的病情稳定，无进展迹象。她的行走能力和症状有了显著改善。虽然GBM最常见于颅内，但原发性脊髓GBM相对罕见。尽管对于幕上GBM已有既定的治疗指南，但脊髓GBM的治疗方案选择仍存在争议，但通常与颅内GBM的治疗方案相似，包括手术、放疗和化疗。交变电场治疗，也称为肿瘤治疗电场（TTFields），适用于颅内GBM的辅助治疗。虽然需要对TTFields在脊髓GBM中的应用进行进一步研究，但TTFields似乎是脊髓GBM的一种安全辅助治疗方法。仍需要进一步研究以找到针对脊髓GBM的改进治疗方法。
