Elsevier

World Neurosurgery

Volume 80, Issue 6, December 2013, Pages e237-e243
World Neurosurgery

Peer-Review Report
Adult Cerebellar Glioblastoma: Understanding Survival and Prognostic Factors Using a Population-Based Database from 1973 to 2009

https://doi.org/10.1016/j.wneu.2013.02.010Get rights and content

Objective

Glioblastoma (GB) is rarely found in the cerebellum. Because of its rarity, it is poorly understood if cerebellar GB (CGB) behaves similarly to supratentorial GB. Studies have been limited to case reports and small case series. A better understanding of CGB may help guide treatment strategies.

Methods

Surveillance, Epidemiology and End Results database was analyzed from 1973 to 2009 for all adult patients with GB located in the cerebellum. Stepwise multivariate proportional hazards regression analyses were used to identify factors independently associated with survival.

Results

Two hundred eight (0.9%) patients with CGB were identified from 23,329 GB patients with known locality. The mean age was 58 years. Median survival was 8 months, with 1-, 2- and 5-year survival rates of 21%, 13%, and 2%. When compared to supratentorial GB, CGB occurred in younger patients (58 ± 16 vs. 61 ± 13 years, P = 0.001), less commonly in Whites (85.6% vs. 91.3%, P = 0.005), and were smaller (3.7 ± 1.1 vs. 4.5 ± 1.7 cm, P = 0.001). A cerebellar location independently predicted poorer survival when compared to other GB locations (P = 0.048). In multivariate analysis for patients with CGB, younger age (P < 0.001), Asian or Pacific Islander race (P = 0.046), and radiation therapy (P < 0.001) were independently associated with prolonged survival.

Conclusion

CGBs are difficult to analyze using institutional series because of their rarity. This study shows they are clinically different from supratentorial GB. Among patients with CGB, radiation therapy may prolong survival. This may help guide treatment strategies aimed at prolonging survival for patients with these extremely rare lesions.

Introduction

Glioblastoma (GB) persists as the most common primary brain neoplasm in adults 6, 10. In addition, several reports have suggested an increasing trend in incidence rates 12, 23, 37. GB is currently recognized as one of the most aggressive types of brain tumor, and unfortunately remains an incurable disease (45). This malignancy rarely arises from the cerebellum, where reports are limited to case reports and small case series 3, 4, 11, 16, 18, 20, 22, 24, 25, 26, 33, 34, 36, 40, 44, 51. Although prognostic factors in supratentorial GBs (STGBs) have been well established 29, 30, 31, these variables are not well characterized for cerebellar GB (CGB) because of their rarity 3, 4, 11, 16, 18, 20, 22, 24, 25, 26, 33, 34, 36, 40, 44, 51. It remains unknown if these tumors behave clinically like their supratentorial counterparts, and if the factors associated with survival for STGBs are the same for CGBs. The goals of this study therefore are to identify and analyze factors associated with survival using data from the population-based Surveillance, Epidemiology, and End Results (SEER) database between 1973 and 2009.

Section snippets

Study Population

The SEER program of the National Cancer Institute includes population-based cancer registries from 20 selected geographic areas in the United States, covering approximately 28% of the U.S. population. Data were obtained from the SEER Program for the years 1973 through 2009. Cases were identified using both the site and histologic codes of the International Classification of Disease for Oncology (ICD-O-3), third edition (19). Only adult cases (≥18 years) classified as GB (ICD-O-3: 9440/3) were

Patient Characteristics

From the 23,329 patients diagnosed with GB, 208 cases (0.9%) were identified in the cerebellum (Table 1). Mean ± standard deviation age was 58 ± 16 years for patients with CGB, with a range from 19 to 88 years. There was a slight predominance of males (58.7%). CGB was mostly diagnosed among Whites (85.6%). Mean tumor size was 3.7 ± 1.1 cm. Furthermore, 81.7% of the patients were coded to have received a surgical intervention, where 28.8% underwent a GTR, 26.0% a partial resection, and 12.5% a

Discussion

In this study, using a national database, there were 208 adult patients with CGB. This is the largest series of CGB to date. Patients with CGB were typically younger, had smaller average tumor sizes, and less typically occurred in Whites as compared to patients with supratentorial lesions. More important, a cerebellar location was independently associated with prolonged survival for patients with GB. For patients with CGB, the median survival was 8 months. Among patients with CGB, the factors

Conclusion

Patients with CGB are rare. We found that the incidence of CGB among patients with GB was 0.9%. These lesions are smaller, occur in younger patients, and comprise different proportions of certain racial ethnicities. More important, patients with CGB have prolonged survival as compared to patients with STGB. The factors independently associated with prolonged survival for patients with CGB are younger age at presentation, radiation therapy, and Asian or Pacific Islander race. These findings may

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    Conflict of interest statement: H. Adams is supported by The Prins Bernhard Cultuurfonds and VSBfonds, The Netherlands. K. L. Chaichana is supported by the National Institute of Health T32 Training grant. J. Avendaño is supported by CONACYT and the National Institute of Neurology and Neurosurgery, Mexico City. A. Quiñones-Hinojosa is supported by the Howard Hughes Medical Institute and the Robert Wood Johnson Foundation. The remaining authors have no conflicts to report.

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