How do you manage glioblastoma presenting with leptomeningeal dissemination?

Hospice is a very legitimate option. As physicians, we recommend this far too infrequently.

In an older person with poor PS who is not symptomatic from the leptomeningeal disease, they are still more likely to suffer from their primary tumor so I think it is reasonable to just ignore it.

I think performance status and prognosis (age, MGMT) are critical. One could argue for a trial of TMZ a...

Have a serious discussion about prognosis, getting affairs in order, and end-of-life care.

Considered initially a rare complication in gliomas, the incidence of LMD is estimated at 4%, reaching 25% on postmortem neuropathological evaluation. There is no standard-of-care treatment for LMS in patients with GBM, although multiple groups have proposed several therapeutic options (e.g., methot...

I'd be eager to hear from other neuro-oncologists on this but generally, in my practice, similar to without LMD. Our chemotherapeutic agents are BBB penetrants, and IT cytotoxic chemotherapy only penetrates a couple of millimeters (so would not address the parenchymal disease). Having said this, I'm...

Also depends on the molecular profile of the GBM. If there is a suitable molecular target, then low threshold to move from TMZ/radiation onto targeted therapy.

All patients with Glioblastoma should have a frank discussion about end-of-life care, health care proxy designation, and advance directives within the first 2-3 visits. I generally have such discussions on the first MRI following chemoradiation therapy, since this is a window of opportunity to think...