Very late complications of oncotherapy in glioblastoma patients: A case series.
corticosteroid
glioblastoma
oncotherapy
stroke-like syndrome
Journal
Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia
ISSN: 1804-7521
Titre abrégé: Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub
Pays: Czech Republic
ID NLM: 101140142
Informations de publication
Date de publication:
May 2022
May 2022
Historique:
received:
28
11
2020
accepted:
29
01
2021
pubmed:
23
2
2021
medline:
20
5
2022
entrez:
22
2
2021
Statut:
ppublish
Résumé
Stroke-like syndrome is defined as a rare, delayed complication of brain oncotherapy. Cases with more favorable brain cancer diagnoses and longer life expectancy have been previously reported, but here we present, for the first time, three long-term survivors of glioblastoma with stroke-like syndromes. Three young or middle-aged patients underwent tumor resection and chemoradiotherapy. They received regular clinical and imaging follow-up with stable neurological status and no signs of tumor recurrence. They exhibited varied signs and symptoms (motor and sensory deficits, aphasia, memory and cognitive disorders, seizures, and headache) accompanied by imaging abnormalities. Stroke-like syndromes developed within 2-5 days and resolved in 2-6 weeks. Diffusion-weighted MRI and T2 brain perfusion abnormalities were demonstrated in all patients. In addition, there was focal T1 MRI contrast enhancement due to blood-brain barrier disruption. In addition to tumor recurrence, classic stroke, encephalitis, metabolic and mitochondrial disorders, and post-seizure swelling should be excluded. The imaging indicated intensive MRI scanning and symptomatic medication (steroids supplemented by antiepileptics, vasoactive agents, etc.) for judicious management. With respect to the course, an invasive procedure was still considered an option. All stroke-like syndromes are diagnoses of exclusion. To avoid misinterpretation of imaging findings as glioblastoma recurrence and avert recall oncotherapy or redundant interventions, better understanding of delayed complications of brain tumor therapy is crucial.
Sections du résumé
BACKGROUND
BACKGROUND
Stroke-like syndrome is defined as a rare, delayed complication of brain oncotherapy. Cases with more favorable brain cancer diagnoses and longer life expectancy have been previously reported, but here we present, for the first time, three long-term survivors of glioblastoma with stroke-like syndromes.
METHODS AND RESULTS
RESULTS
Three young or middle-aged patients underwent tumor resection and chemoradiotherapy. They received regular clinical and imaging follow-up with stable neurological status and no signs of tumor recurrence. They exhibited varied signs and symptoms (motor and sensory deficits, aphasia, memory and cognitive disorders, seizures, and headache) accompanied by imaging abnormalities. Stroke-like syndromes developed within 2-5 days and resolved in 2-6 weeks. Diffusion-weighted MRI and T2 brain perfusion abnormalities were demonstrated in all patients. In addition, there was focal T1 MRI contrast enhancement due to blood-brain barrier disruption. In addition to tumor recurrence, classic stroke, encephalitis, metabolic and mitochondrial disorders, and post-seizure swelling should be excluded. The imaging indicated intensive MRI scanning and symptomatic medication (steroids supplemented by antiepileptics, vasoactive agents, etc.) for judicious management. With respect to the course, an invasive procedure was still considered an option.
CONCLUSION
CONCLUSIONS
All stroke-like syndromes are diagnoses of exclusion. To avoid misinterpretation of imaging findings as glioblastoma recurrence and avert recall oncotherapy or redundant interventions, better understanding of delayed complications of brain tumor therapy is crucial.
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
236-241Déclaration de conflit d'intérêts
The authors report no conflicts of interest in this work.
Références
Sheikh S, Radivoyevitch T, Barnholtz-Sloan JS, Vogelbaum M. Long-term trends in glioblastoma survival: implications for historical control groups in clinical trials. Neuroocol Pract 2020;7(2):158-63.
doi: 10.1093/nop/npz046
Lim SY, Brooke J, Dineen R, O'Donoghue M. Stroke-like migraine attack after cranial radiation therapy: the SMART syndrome. Pract Neurol 2016;16(5):406-8.
doi: 10.1136/practneurol-2016-001385
Di Stefano AL, Berzero G, Ducray F, Eoli M, Pichiecchio A, Farina LM, Cuccarini V, Brunelli MC, Diamanti L, Condette Auliac S, Salmaggi A, Silvani A, Giometto B, Pace A, Vidiri A, Bourdain F, Bastianello S, Ceroni M, Marchioni E. Stroke-like events after brain radiotherapy: a large series with long-term follow-up. E. Eur J Neurol 2019;26(4):639-50.
doi: 10.1111/ene.13870
Di Stefano AL, Berzero G, Vitali P, Galimberti CA, Ducray F, Ceroni M, Bastianello S, Colombo AA, Simoncelli A, Brunelli MC, Giometto B, Diamanti L, Gaviani P, Salmaggi A, Silvani A, Marchioni E. Acute late-onset encephalopathy after radiotherapy: an unusual life-threatening complication. Neurology 2013;81:1014-7.
pubmed: 23935180
doi: 10.1212/WNL.0b013e3182a43b1f
Urbanovska I, Houdova Megova M, Kalita O, Uvirova M, Simova J, Tuckova L, Buzrla P, Palecek T, Hajduch M, Dvorackova J, Drabek J. IDH1 mutation analysis by CADMA compared with SNaPshot assay and two immunohistochemical methods. Pathol Oncol Res 2019;25(3):971-78.
doi: 10.1007/s12253-018-0413-9
Biju RK, Dower A, Moon BG, Gan P. SMART (Stroke-Like Migraine Attacks After Radiation Therapy) syndrome: A case study with imaging supporting the theory of vascular dysfunction. Am J Case Rep 2020;28;21:e921795.
doi: 10.12659/AJCR.921795
Stupp R, Hegi ME, Mason WP, et van den Bent MJ, Taphoorn MJ, Janzer RC, Ludwin SK, Allgeier A, Fisher B, Belanger K, Hau P, Brandes AA, Gijtenbeek J, Marosi C, Vecht CJ, Mokhtari K, Wesseling P, Villa S, Eisenhauer E, Gorlia T, Weller M, Lacombe D, Cairncross JG, Mirimanoff RO; European Organisation for Research and Treatment of Cancer Brain Tumour and Radiation Oncology Groups; National Cancer Institute of Canada Clinical Trials Group. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol 2009;10:459-66.
doi: 10.1016/S1470-2045(09)70025-7
Wen PY, Weller M, Lee EQ, Alexander BM, Barnholtz-Sloan JS, Barthel FP, Batchelor TT, Bindra RS, Chang SM, Chiocca EA, Cloughesy TF, DeGroot JF, Galanis E, Gilbert MR, Hegi ME, Horbinski C, Huang RY, Lassman AB, Le Rhun E, Lim M, Mehta MP, Mellinghoff IK, Minniti G, Nathanson D, Platten M, Preusser M, Roth P, Sanson M, Schiff D, Short SC, Taphoorn MJB, Tonn JC, Tsang J, Verhaak RGW, von Deimling A, Wick W, Zadeh G, Reardon DA, Aldape KD, van den Bent MJ. Glioblastoma in adults: A Society for Neuro-Oncology (SNO) and European Society of Neuro-Oncology (EANO) consensus review on current management and future directions. Neuro Oncol 2020;22(8):1073-113.
doi: 10.1093/neuonc/noaa106
Black DF, Morris JM, Lindell EP, Krecke KN, Worrell GA, Bartleson JD, Lachance DH. Stroke-like migraine attacks after radiation therapy (SMART) syndrome is not always completely reversible: a case series. Am J Neuroradiol 2013;34(12):2298-303.
doi: 10.3174/ajnr.A3602
Wilke C, Grosshans D, Duman J, Brown P, Li J. Radiation-induced cognitive toxicity: pathophysiology and interventions to reduce toxicity in adults. Neuro Oncol 2018;20(5):597-607.
doi: 10.1093/neuonc/nox195