What is your preferred treatment for spinal drop metastases from a glioblastoma?

This is a relatively uncommon, but challenging clinical situation, and usually the prognosis is poor. Our approach is as follows:

1. Detailed MR imaging of the spine to ensure that the failure is truly focal, and not multifocal or leptomeningeal:

2. Thorough re-imaging of the brain to ensure that there is no progression of disease in the brain.

3. Underscore the value of knowing MGMT (and if possible IDH) status from the primary tumor.

4. Neurosurgical evaluation regarding resectability.

5. Performance and neurologic functional evaluation

The reason for doing all of the above is to categorize the patients into one of two broad groups:

a. "Better risk": focal relapse, after a long interval from diagnosis of the primary, MGMT methylated, goo...