Clinical commentaryFrontal glioblastoma multiforme may be biologically distinct from non-frontal and multilobar tumors

- Isocitrate dehydrogenase 1 (IDH1) mutated glioblastoma multiforme (GBM) is more likely to be localized to the frontal lobe compared to IDH1 wild type GBM.
- O(6)-methylguanine-methyltransferase (MGMT) methylated GBM is more commonly localized to the frontal lobe than unmethylated tumor.
- Increasing cutoffs for Ki67 proliferation index correlate to a lower incidence of multifocal GBM.
- GBM with high Ki67 index (>30%) are more likely to be in the frontal lobe than lower Ki67 GBM.

Glioblastoma multiforme (GBM) is the most common primary brain tumor in adults and carries a grim prognosis. Lobar GBM, notably those localized to the frontal lobe, are generally more amenable to complete surgical resection, and may carry a better prognosis. The biology of differently localized GBM has been reported scarcely in terms of prognostic markers, including isocitrate dehydrogenase 1 (IDH1) mutation and O(6)-methylguanine-methyltransferase (MGMT) methylation. To our knowledge, there has been no evaluation in the literature of different proliferation indexes in different GBM locations in the brain. We performed a retrospective evaluation of our prospectively collected database to assess the rate of IDH1 positivity, MGMT methylation and Ki67 index for GBM located in the frontal lobes alone, lobar GBM in other supra-tentorial lobes and multilobar GBM. IDH1 mutated tumors were localized in the frontal lobes in 50.0%, whereas only 20.3% of IDH1 wild-type tumors were localized in the frontal lobe (p = 0.006); MGMT methylated tumors were localized in the frontal lobe in 32.0% of the cases. Only 13.75% of the MGMT unmethylated tumors were localized to the frontal lobe (p = 0.005); Tumors with higher Ki67 proliferation index were more likely to be localized in the frontal lobe (40.6% vs. 19.5%, p = 0.019). This is the largest cohort of GBM assessed for these purposes in the literature. Frontal lobe GBMs may be intrinsically biologically distinct from GBM in other lobes and from multilobar tumors.