Extremely Long-Term Glioblastoma Survival (Ten Years): A Possible Role of Immune Modulation From Pre-existing Diseases

Abstract

Glioblastoma (World Health Organization grade 4 astrocytoma) is the most common and aggressive primary brain tumor in adults, with a median survival of 12-15 months despite maximal treatment. Nevertheless, a small subset of patients (approximately 3-5%) survive beyond three years, and fewer than 1% live longer than a decade. Over recent decades, survival outcomes have improved modestly, largely attributable to advancements in surgical techniques, radiotherapy, and chemotherapy. Long-term survival in glioblastoma is thought to arise from a multifactorial interplay between tumor biology, therapeutic response, and host-related characteristics, including immunologic status and systemic conditions that may influence tumor behavior. We report the case of a 54-year-old woman who survived more than ten years following a diagnosis of glioblastoma. Her medical history included Crohn's disease, cigarette smoking, and syphilis treated with penicillin at the age of 21. The patient underwent gross total resection of a left fronto-insular lesion, followed by standard chemoradiotherapy and maintenance temozolomide. Remarkably, ten years after diagnosis, she remains recurrence-free, with a Karnofsky Performance Score of 80 and only mild cognitive impairment attributable to late radiotherapy effects. This case exemplifies an exceptionally favorable long-term outcome in glioblastoma and suggests a potential role for immune modulation associated with chronic inflammatory or infectious conditions in influencing disease course. Further investigation into host-related immune mechanisms may help elucidate factors contributing to durable tumor control in rare long-term survivors.