Radiotherapy combined with targeted therapy and immunotherapy for ventricular disseminated recurrent glioblastoma surviving for 2.5 years:a case report and literature review

GUO Xiao-peng; WANG Yu; MA Wen-bin

doi:10.13798/j.issn.1009-153X.2024.12.004

Abstract：Objective To explore the treatment methods and efficacy of ventricular disseminated recurrent glioblastoma multiforme(GBM).Methods A retrospective analysis was conducted on the clinical data of a patient with ventricular disseminated recurrent GBM,and the relevant literature was summarized and analyzed.Results The patient was a 57-year-old male who underwent craniotomy for total resection of a right temporal-parietal lobe mass.The postoperative pathology showed IDH wild-type GBM(WHO grade 4)with unmethylated MGMT promoter.The patient received standard Stupp protocol treatment after surgery.One year after surgery,MRI showed nodular enhancement near the interventricular foramen and septum pellucidum on the left ventricular wall,suggesting disease progression.Five days of chemotherapy was administered,but it was stopped due to severe immunosuppression and severe pneumonia.Four months later,MRI showed significant enlargement of nodular enhancement in the left caudate nucleus,genu of the corpus callosum,and septum pellucidum.Three-dimensional intensity-modulated radiotherapy was performed on the new lesions.One month later,MRI showed continued disease progression with soft meningeal enhancement in both lateral ventricles and the fourth ventricle,indicating ventricular dissemination.Subsequently,two courses of combined treatment with pembrolizumab(PD-1 inhibitor)and bevacizumab were administered,and the lesions completely disappeared.Two years later,the patient stopped the monoclonal antibody treatment on his own.Six months after drug withdrawal,MRI showed extensive lesions in the left ventricle.Monoclonal antibody treatment was resumed,but the lesions still progressed rapidly.One month later,MRI showed that the left lateral ventricle and the fourth ventricle were completely filled with enhanced lesions.The patient died two months later.Conclusion The total survival period of this case exceeded 4 years,and the survival period after ventricular dissemination was approximately 2.5 years.This suggests that radiotherapy combined with targeted therapy and immunotherapy may be a potential treatment option for patients with recurrent GBM.