Early clinical and neuroradiological worsening after radiotherapy and concomitant temozolomide in patients with glioblastoma: Tumour progression or radionecrosis?

Abstract Objectives This study investigates the diagnosis and management of patients with resected brain glioblastomas who presented early clinical and neuroradiological worsening after the completion of the Stupp protocol. Its aim is to discuss the occurrence of early radionecrosis. Methods Fifty p...

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Bibliographic Details
Published in:Clinical neurology and neurosurgery 2009-05, Vol.111 (4), p.331-334
Main Authors: Peca, C, Pacelli, R, Elefante, A, Del Basso De Caro, M.L, Vergara, P, Mariniello, G, Giamundo, A, Maiuri, F
Format: Article
Language:English
Subjects:
Adult
Aged
Antineoplastic Agents, Alkylating - administration & dosage
Antineoplastic Agents, Alkylating - therapeutic use
Ataxia
Ataxia - etiology
Biological and medical sciences
Brain Neoplasms - drug therapy
Brain Neoplasms - radiotherapy
Brain Neoplasms - surgery
Cancer
Cell cycle
Chemotherapy, Adjuvant
Confusion - etiology
Dacarbazine - administration & dosage
Dacarbazine - analogs & derivatives
Dacarbazine - therapeutic use
Diagnosis, Differential
Female
Follow-Up Studies
Glioblastoma
Glioblastoma - drug therapy
Glioblastoma - radiotherapy
Glioblastoma - surgery
Humans
Magnetic Resonance Spectroscopy
Male
Medical sciences
Middle Aged
Necrosis
Neoplasm Recurrence, Local - complications
Neoplasm Recurrence, Local - diagnosis
Neurology
Neurosurgery
Pituitary gland
Radiation Injuries - complications
Radiation Injuries - diagnosis
Radiation Injuries - etiology
Radiation therapy
Radiation Tolerance - drug effects
Radionecrosis
Radiotherapy, Adjuvant
Recurrence
Reoperation
Spectrum analysis
Studies
Surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Temozolomide
Treatment Outcome
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Summary:Abstract Objectives This study investigates the diagnosis and management of patients with resected brain glioblastomas who presented early clinical and neuroradiological worsening after the completion of the Stupp protocol. Its aim is to discuss the occurrence of early radionecrosis. Methods Fifty patients with brain glioblastoma treated by surgical resection and Stupp protocol were reviewed; 15 among them (30%) had early clinical and neuroradiological worsening at the 6-month follow-up. The MR spectroscopy and surgical findings of these patients are reviewed. Results MR spectroscopy was in favour of tumour recurrence in 14 among 15 patients and showed radionecrosis in one. Among 10 patients who were reoperated on, 7 had histologically verified tumour recurrence or regrowth, whereas in 3 histopathology showed necrosis without evidence of tumour. The 7 patients with tumour progression had prevalence of focal neuroradiological signs (6/7) and a survival of 7.5–12 months (median survival 10 months). The 4 patients with early radionecrosis (including one patient who was not reoperated on) had clinical worsening with mental deterioration, confusion and ataxia, and MR spectroscopy positive for tumour recurrence in 3. Three were alive 24–30 months after the end of the radiotherapy, whereas one died at 40 months. Conclusion Early radionecrosis after the Stupp protocol is not a rare event due to the radiosensitization effect of temozolomide. This phenomenon may predict a durable response to radiotherapy. MR spectroscopy may simulate tumour recurrence. A correct diagnosis is necessary to avoid useless reoperations and incorrect withdrawal of temozolomide.
ISSN:0303-8467
1872-6968
DOI:10.1016/j.clineuro.2008.11.003