We investigated the mode of death associated with malignant brain tumors or low-grade gliomas with progression. 

Malignant brain tumors typically lead to neurological decline, followed by death. Research is limited regarding specific modes of neurological death, which include failure of the cerebral hemispheres (“cerebral failure”), cerebral mass effect (due to tumor, peritumoral edema), brainstem failure, hydrocephalus, and posterior fossa mass effect.

We conducted a retrospective review of malignant brain tumors or low-grade gliomas with progression. Patients were identified from the lists of two neuro-oncologists. Patients were diagnosed since 2012, had a brain MRI or head CT within four weeks of death, and died from a neurological cause. Exclusion criteria include a diagnosis of brain metastasis, complications of surgery contributing to death, death from infection (with the exception of pneumonia accompanying advanced neurological worsening), and inadequate medical records. Mode of death was determined by an experienced neuro-oncologist based on data from brain imaging and medical records. 

59 patients were included in this preliminary analysis. Patients were predominantly White/Caucasian (95%) and Black/African American (5%); none were Hispanic. Median age was 55 years (range 21-86) at diagnosis and 57 at death. Median survival was 17 months (range 1-95) from diagnosis. 45 (76%) identified as men and 15 (24%) as women. Tumor diagnoses were glioblastoma (72%), primary CNS lymphoma (10%), other glioma (7%), astrocytoma (5%), oligodendroglioma (2%), and CNS germ cell tumor (2%). 79% of patients had a sole primary mode of death, while 21% had multiple. Primary modes of death were cerebral failure (70%), cerebral mass effect (31%), brainstem failure (13%), and hydrocephalus (5%). 

Failure of cerebral hemispheres was the most common mode of death in the studied patient population. These results will help inform end-of-life care for adults with malignant brain tumors.