Multicentric non-enhancing lesions in glioblastoma: A retrospective study

J Clin Neurosci. 2021 Mar:85:20-26. doi: 10.1016/j.jocn.2020.11.050. Epub 2021 Jan 3.


Glioblastoma (GBM) typically presents as a single lesion. Multicentric GBM are defined as well separated lesions on MRI (enhancing and non-enhancing). Multicentric GBM with non-enhancing lesions (MNE-GBM) are rarely described in literature. We aimed at describing the radiologic characteristics, treatment, and clinical course of those patients. The institutional neuropathological database was searched for GBM patients diagnosed between 1/1/2015 and 31/05/2018. All pre-operative MRI brain scans were reviewed to identify patients with MNE-GBM. Electronic medical records and follow-up MRI scans were reviewed to assess progression-free survival (PFS) and overall survival (OS). Out of 149 adult patients with newly diagnosed GBM, 12 met the inclusion criteria of MNE-GBM, all of them presented at least one enhancing lesion. Median follow-up for the MNE-GBM patients was 16.1 months. At last follow-up, all patients had recurrence (median PFS 7.6 months) and eleven patients had deceased. Median OS was 16.2 months (95% CI, 4.1-27.5). Eleven patients received radiotherapy concomitant with temozolomide as initial treatment. Radiation field included all the disease foci (enhancing and non-enhancing lesions) in 8 patients, five of them progressed within the non-enhancing lesion. Three patients did not receive radiation for the entire non-enhancing lesions, and two of them progressed within the non-irradiated areas. In conclusion, MNE-GBM is not rare, and has high risk of aggressive progression within the separate non-enhancing lesion.

Keywords: FLAIR; MRI; Multicentric glioblastoma; Non-enhancing lesion; Radiotherapy.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents, Alkylating / therapeutic use
  • Brain Neoplasms / diagnostic imaging
  • Brain Neoplasms / pathology*
  • Brain Neoplasms / therapy
  • Chemoradiotherapy / methods
  • Female
  • Glioblastoma / diagnostic imaging
  • Glioblastoma / pathology*
  • Glioblastoma / therapy
  • Humans
  • Magnetic Resonance Imaging
  • Middle Aged
  • Progression-Free Survival
  • Retrospective Studies
  • Temozolomide / therapeutic use
  • Young Adult


  • Antineoplastic Agents, Alkylating
  • Temozolomide