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01-03-2017 | Glioblastoma multiforme | Article

Multilesion glioblastoma multiforme in the modern chemo-radiotherapy era: an analysis of pattern of failure and overall survival

Journal of Radiation Oncology

Authors: Daniel M. Trifiletti, Colin Hill, Allison Garda, Suraj Kabadi, Neil R. Shah, Jason P. Sheehan, James M. Larner

Publisher: Springer Berlin Heidelberg



We sought to evaluate the pattern of disease progression and survival of patients with multilesion glioblastoma (GBM) in a modern patient cohort.


We retrospectively collected the clinical data of patients over 2004–2014 with newly diagnosed GBM. Following resection (or biopsy), all patients received radiotherapy to 60 Gy in 30 fractions with concurrent and adjuvant temozolomide. Preoperative MRIs were reviewed by a single diagnostic radiologist blinded to treatment outcomes and categorized as single focus or multilesion (multifocal/multicentric). Multifocal tumors were defined as noncontiguous enhancement along known neural pathways and multicentric tumors were defined as noncontiguous enhancement along disjointed pathways (i.e., different lobes). Univariate and multivariate (MVA) analyses were performed to investigate factors prognostic of overall survival.


Of 155 eligible patients, 30 presented with a multilesion tumor focus (19.4%). Of the patients that developed recurrent disease before death (n = 123), the predominant pattern of failure was local (80%) and did not differ by focality (p = 0.18). Unifocal, multifocal, and multicentric tumors demonstrated similar actuarial disease progression (p = 0.12). Median survival was inferior in patients with multifocal and multicentric disease compared to unifocal disease (11.5, 7.1, and 18.0 months, respectively, p = 0.009). On MVA, factors prognostic of overall survival included age ≥70 (HR 3.89, p < 0.001), MGMT promoter hypermethylation (HR 0.21, p = 0.004), IDH1/2 mutation status (p = 0.044), and multicentric tumors (HR 7.18, p = 0.002). Extent of tumor resection did not impact OS (p = 0.308).


We identified unifocal, multifocal, and multicentric GBM entities with differing overall survival following modern chemo-radiotherapy techniques despite similar pattern of disease progression.

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