Butterfly glioblastomas: a retrospective review and qualitative assessment of outcomes

Abstract

To address a paucity of literature and treatment guidelines regarding the management of butterfly glioblastomas, we performed a ten year retrospective analysis of data from twenty-three consecutive patients treated for this disease at a single institution. Clinical characteristics and outcomes were assessed. Median age was 59 years; 52 % were female; median preoperative Karnofsky performance score (KPS) was 80. Twelve patients underwent biopsy and eleven underwent surgical decompression. The median tumor volume for the biopsy group was 60.6 cm(3) and for the surgically decompressed group 40.5 cm(3). In the biopsy group, five patients received adjuvant therapy but one died prior to its completion; two died prior to the initiation of adjuvant therapy and five were lost to follow up. In the surgical decompression group, seven patients received adjuvant therapy, one died prior to the initiation of adjuvant therapy, two were treated with palliative measures only, and one was lost to follow up. Kaplan-Meier estimates of overall median post surgical-survival of the whole group was 180 days, the biopsy group 48 days, and the surgically decompressed group 265 days (p = 0.14). Our results show that there was a higher median survival in the surgically decompressed group; but a direct correlation could not be established, and that the median KPS did not improve in either group after treatment. A larger multicenter review is required to quantitatively assess the factors, including tumor biomarkers that are associated with patient outcome.

Fig. 1

Representative patient MRI a coronal and b axial views demonstrating a butterfly glioblastoma. There is contiguous involvement of both hemispheres, with disease crossing the genu of the corpus callosum

Fig. 2

Kaplan–Meier plots of a overall survival of the entire cohort of patients with a butterfly glioblastoma and b the cohort of patients having undergone surgical biopsy compared to the cohort having undergone surgical decompression. All patients were included regardless of having received adjuvant therapy. Median survival for the biopsy group was 48 days compared to the surgically decompressed group of 265 days, p = 0.14 (log-rank)