Temozolomide

Abstract

Brain tissue necrosis and tumour pseudoprogression: 5 case reports In a retrospective analysis of 60 patients, conducted between December 1997 and November 2015, five patients (3 women and 2 men) aged 37–66 years were described, who experienced brain tissue necrosis or tumour pseudoprogression during treatment with temozolomide for brain tumour [routes and dosages not stated]. A 37-year-old woman, who underwent chemoradiation involving temozolomide and radiotherapy for a brain tumour, was found to have anaplastic oligoastrocytoma status post chemoradiation. At 13 months after radiotherapy, a biopsy confirmed onset of tissue necrosis, presenting as multiple contrast-enhancing lesions on MRI, accompanied by new neurological symptoms. A diagnosis of brain tissue necrosis was made. She was treated with bevacizumab, resulting in the gradual regression of lesions. A 43-year-old woman, who underwent chemoradiation involving temozolomide and radiotherapy for a brain tumour, was found to have anaplastic astrocytoma status post chemoradiation. At 11 months after radiotherapy, a biopsy confirmed onset of tissue necrosis, presenting as multiple contrast enhancing lesions on MRI, accompanied by new neurological symptoms. A diagnosis of brain tissue necrosis was made. The lesions were managed with steroids. Eight of nine lesions radiographically resolved within 6–26 months of onset. A 39-year-old man, who underwent chemoradiation involving temozolomide and radiotherapy for a brain tumour, was found to have glioblastoma multiforme status post chemoradiation. At 3 months after chemoradiation, an MRI performed during active antineoplastic treatment revealed increased contrast enhancement around the resection cavity. The lesion was accompanied by new neurological symptoms. A diagnosis of tumour pseudoprogression was made, which was managed with unspecified steroids and surgical debulking at 7 months following onset, showing extensive tissue necrosis. A 65-year-old woman, who underwent chemoradiation involving temozolomide and radiotherapy for a brain tumour, was found to have glioblastoma multiforme status post chemoradiation. At 1 month after chemoradiation, an MRI performed during active antineoplastic treatment revealed increased contrast enhancement around the resection cavity. The lesion was associated with new neurological symptoms. A diagnosis of tumour pseudoprogression was made. She was treated with unspecified steroids. At 4 months after onset, the lesions partially debulked, and they resolved at 9 months following onset. Histopathology demonstrated predominant tissue necrosis with few, scattered residual tumour cells. A 66-year-old man, who underwent chemoradiation involving temozolomide and radiotherapy for a brain tumour, was found to have glioblastoma multiforme status post chemoradiation. At 1 month after chemoradiation, an MRI performed during active antineoplastic treatment revealed increased contrast enhancement around the resection cavity. The lesion was accompanied by new neurological symptoms. A diagnosis of tumour pseudoprogression was made. He was treated with unspecified steroids. At 4 months after onset, the lesion was resected completely, which revealed extensive tissue necrosis.