Abstract
Recurrence of malignant glioma following radiotherapy most commonly occurs in close proximity to the original contrast enhancing CT/MRI tumor volume. For this reason current radiation planning favors focal radiotherapy fields designed to cover the preoperative tumor contrast enhancing volume ± surrounding edema with a 2–4 centimetre margin. Two patients with bifrontal malignant gliomas treated with such radiotherapy fields experienced out of field tumor progression while on treatment. Posterior extension along the corpus callosum, not evident on pretreatment imaging, was hypothesized as the cause of the geographic miss. The literature documenting recurrence patterns of malignant glioma following radiotherapy support focal field radiotherapy fields for most patients with malignant glioma. Reporting bias may exist in the literature, however, due to the whole brain radiotherapy used in older series reporting recurrence patterns and exclusion of patients with bihemispheric or more locally extensive tumors in more modern series. Tumor location and pattern of growth at presentation may be important factors in predicting patterns of spread and relapse after radiotherapy.
Similar content being viewed by others
References
Halperin EC, Berger PC, Bullard DE: The fallacy of the localized supratentorial malignant glioma. Int J Radiat Oncol Biol Phys 15: 505–509, 1988
Burger PC, Dubois PJ, Schold SC, Smith KR, Odom GL, Crafts DC, Giangaspero F: Computerized tomographic and pathologic studies of the untreated, quiescent, and recurrent glioblastoma multiforme. J Neurosurg 58: 159–169, 1983
Burger PC, Heinz ER, Shibata T, Kleihues P: Topographic anatomy and CT correlations in the untreated glioblastoma multiforme. J Neurosurg 68: 698–704, 1988
Coons SW, Johnson PC: Histopathology of astrocytomas: Grading, patterns of spread and correlation with modern imaging modalities. Sem Radiat Oncol 1: 2–9, 1991
Gaspar LE, Fisher BJ, Macdonald DR, LeBer DV, Halperin EC, Schold SC, Cairncross JG: Supratentorial malignant glioma: Patterns of recurrence and implications for external beam local therapy. Int J Radiat Oncol Biol Phys 24: 55–57, 1992
Halperin EC, Bentel G, Heinz ER, Burger PC: Radiation therapy treatment planning in supratentorial glioblastoma multiforme: An analysis based on post mortem topographic anatomy with CT correlations. Int J Radiat Oncol Biol Phys 17: 1347–1350, 1989
Hochberg FH, Pruit A: Assumptions in the radiotherapy of glioblastoma. Neurology 30: 907–911, 1980
Kelly PJ, Daumas-Duport C, Scheithauer BW, Ball BA, Kispert DB: Stereotactic histologic correlations of computed tomography and magnetic resonance imaging-defined abnormalities in patients with glial neoplasms. Mayo Clin Proc 62: 450–459, 1987
Kelly PJ, Daumas-Duport C, Kispert DB, Bernd MS, Scheithauer BW, Illig JJ: Imaging-based stereotactic serial biopsies in untreated intracranial glial neoplasms. J Neurosurg 66: 865–874, 1987
Matsukado Y, MacCarty CS, Kernohan JW: The growth of glioblastoma multiforme (astrocytomas, grades 3 and 4) in neurosurgical practice. J Neurosurgery 18: 636–644, 1961
Sneed PK, Gutin PH, Larson DA, Malec MK, Phillips TL, Prados MD, Scharfen CO, Weaver KA, Wara WM: Patterns of recurrence of glioblastoma multiforme after external irradiation followed by implant boost. Int J Radiat Oncol Biol Phys 29: 719–727, 1994
Wallner KE, Glaicich JH, Krol G, Arbit E, Malkin MG: Patterns of failure following treatment for glioblastoma multiforme and anaplastic astrocytoma. Int J Radiat Oncol Biol Phys 16: 1405, 1989
Lee SW, Herbort K, Martel MK, Marsh LH, Gebarski SS, Radany EH: Patterns of failure following 3-D conformal dose escalation. Radiotherapy for high grade astrocytomas – A quantitative dosimetric study. Int J Radiat Oncol Biol Phys 36: 159, 1996
Barker FG, Prados MD, Chang SM, Gutin PH, Lamborn KR, Larson DA, Malec MK, McDermott MW, Sneed PK, Wara WM, Wilson CB: Radiation response and survival time in patients with glioblastoma multiforme. J Neurosurg 58: 159–169, 1983
Halperin EC, Herdon J, Schold SC, Brown M, Vick N, Cairncross JG, Macdonald DR, Gaspar L, Fisher B, Dropcho E, Rosenfeld S, Morowitz R, Piepmeier J, Hait W, Byrne T, Salter M, Imperato J, Khandekar J, Paleologos N, Burger P, Bentel GC, Friedman A: A phase III randomized prospective trial of external beam radiotherapy, mitomycin C, carmustin, and 6-mercaptopurine for the treatment of adults with anaplastic glioma of the brain. CNS Cancer Consortium. Int J Radiat Oncol Biol Phys 34: 793–802, 1996
Scott CB, Scarantino C, Urtasun R, Movsas B, Jones CU, Simpson JR, Fischbach AJ: Validation and predictive power of Radiation Therapy Oncology Group (RTOG) recursive partitioning analysis classes for malignant glioma patients: A report using RTOG 90-06. Int J Radiat Oncol Biol Phys 36: 160, 1996
Thornton AF, Hegarty TJ, Haken RK, Yanke BR, LaVigne ML, Fraass BA, McShan DL, Sandler HG: Three-dimensional treatment planning of astrocytomas: A dosimetric study of cerebral irradiation. Int J Radiat Oncol Biol Phys 20: 1309–1315, 1991
Geer CP, Grossman SA: Interstitial fluid flow along white matter tracts: A potentially important mechanism for the dissemination of primary brain tumors. J Neuro-Oncol 32(3): 193–201, 1997
Archibald YM, Lunn D, Ruttan LA, Macdonald DR, Del Maestro6RF, Barr HWK, Pexman JHW, Fisher BJ, Gaspar LE, Cairncross JG: Cognitive functioning in long-term survivors of high-grade glioma. J Neurosurg 80: 247–253, 1994
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Bauman, G.S., Fisher, B.J., Cairncross, J.G. et al. Bihemispheric malignant glioma: One size does not fit all. J Neurooncol 38, 83–89 (1998). https://doi.org/10.1023/A:1005985211037
Issue Date:
DOI: https://doi.org/10.1023/A:1005985211037