Brain Magnetic Resonance Imaging After High-Dose Chemotherapy and Radiotherapy for Childhood Brain Tumors

Filippo Spreafico, Lorenza Gandola, Alfonso Marchianò, Fabio Simonetti, Geraldina Poggi, Anna Adduci, Carlo Alfredo Clerici, Roberto Luksch, Veronica Biassoni, Cristina Meazza, Serena Catania, Monica Terenziani, Renato Musumeci, Franca Fossati-Bellani, Maura Massimino

Research output: Contribution to journalArticle

Abstract

Purpose: Brain necrosis or other subacute iatrogenic reactions has been recognized as a potential complication of radiotherapy (RT), although the possible synergistic effects of high-dose chemotherapy and RT might have been underestimated. Methods and Materials: We reviewed the clinical and radiologic data of 49 consecutive children with malignant brain tumors treated with high-dose thiotepa and autologous hematopoietic stem cell rescue, preceded or followed by RT. The patients were assessed for neurocognitive tests to identify any correlation with magnetic resonance imaging (MRI) anomalies. Results: Of the 49 children, 18 (6 of 25 with high-grade gliomas and 12 of 24 with primitive neuroectodermal tumors) had abnormal brain MRI findings occurring a median of 8 months (range, 2-39 months) after RT and beginning to regress a median of 13 months (range, 2-26 months) after onset. The most common lesion pattern involved multiple pseudonodular, millimeter-size, T 1-weighted unevenly enhancing, and T 2-weighted hyperintense foci. Four patients with primitive neuroectodermal tumors also had subdural fluid leaks, with meningeal enhancement over the effusion. One-half of the patients had symptoms relating to the new radiographic findings. The MRI lesion-free survival rate was 74% ± 6% at 1 year and 57% ± 8% at 2 years. The number of marrow ablative courses correlated significantly to the incidence of radiographic anomalies. No significant difference was found in intelligent quotient scores between children with and without radiographic changes. Conclusion: Multiple enhancing cerebral lesions were frequently seen on MRI scans soon after high-dose chemotherapy and RT. Such findings pose a major diagnostic challenge in terms of their differential diagnosis vis-à-vis recurrent tumor. Their correlation with neurocognitive results deserves further investigation.

Original languageEnglish
Pages (from-to)1011-1019
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Volume70
Issue number4
DOIs
Publication statusPublished - Mar 15 2008

Fingerprint

chemotherapy
Brain Neoplasms
brain
magnetic resonance
radiation therapy
Radiotherapy
tumors
Magnetic Resonance Imaging
Drug Therapy
dosage
lesions
Brain
Primitive Neuroectodermal Tumors
anomalies
Thiotepa
quotients
stem cells
necrosis
Hematopoietic Stem Cells
Glioma

Keywords

  • Brain tumors
  • High-dose chemotherapy
  • Iatrogenic effects
  • Magnetic resonance imaging
  • Neurotoxicity

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

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title = "Brain Magnetic Resonance Imaging After High-Dose Chemotherapy and Radiotherapy for Childhood Brain Tumors",
abstract = "Purpose: Brain necrosis or other subacute iatrogenic reactions has been recognized as a potential complication of radiotherapy (RT), although the possible synergistic effects of high-dose chemotherapy and RT might have been underestimated. Methods and Materials: We reviewed the clinical and radiologic data of 49 consecutive children with malignant brain tumors treated with high-dose thiotepa and autologous hematopoietic stem cell rescue, preceded or followed by RT. The patients were assessed for neurocognitive tests to identify any correlation with magnetic resonance imaging (MRI) anomalies. Results: Of the 49 children, 18 (6 of 25 with high-grade gliomas and 12 of 24 with primitive neuroectodermal tumors) had abnormal brain MRI findings occurring a median of 8 months (range, 2-39 months) after RT and beginning to regress a median of 13 months (range, 2-26 months) after onset. The most common lesion pattern involved multiple pseudonodular, millimeter-size, T 1-weighted unevenly enhancing, and T 2-weighted hyperintense foci. Four patients with primitive neuroectodermal tumors also had subdural fluid leaks, with meningeal enhancement over the effusion. One-half of the patients had symptoms relating to the new radiographic findings. The MRI lesion-free survival rate was 74{\%} ± 6{\%} at 1 year and 57{\%} ± 8{\%} at 2 years. The number of marrow ablative courses correlated significantly to the incidence of radiographic anomalies. No significant difference was found in intelligent quotient scores between children with and without radiographic changes. Conclusion: Multiple enhancing cerebral lesions were frequently seen on MRI scans soon after high-dose chemotherapy and RT. Such findings pose a major diagnostic challenge in terms of their differential diagnosis vis-{\`a}-vis recurrent tumor. Their correlation with neurocognitive results deserves further investigation.",
keywords = "Brain tumors, High-dose chemotherapy, Iatrogenic effects, Magnetic resonance imaging, Neurotoxicity",
author = "Filippo Spreafico and Lorenza Gandola and Alfonso Marchian{\`o} and Fabio Simonetti and Geraldina Poggi and Anna Adduci and Clerici, {Carlo Alfredo} and Roberto Luksch and Veronica Biassoni and Cristina Meazza and Serena Catania and Monica Terenziani and Renato Musumeci and Franca Fossati-Bellani and Maura Massimino",
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TY - JOUR

T1 - Brain Magnetic Resonance Imaging After High-Dose Chemotherapy and Radiotherapy for Childhood Brain Tumors

AU - Spreafico, Filippo

AU - Gandola, Lorenza

AU - Marchianò, Alfonso

AU - Simonetti, Fabio

AU - Poggi, Geraldina

AU - Adduci, Anna

AU - Clerici, Carlo Alfredo

AU - Luksch, Roberto

AU - Biassoni, Veronica

AU - Meazza, Cristina

AU - Catania, Serena

AU - Terenziani, Monica

AU - Musumeci, Renato

AU - Fossati-Bellani, Franca

AU - Massimino, Maura

PY - 2008/3/15

Y1 - 2008/3/15

N2 - Purpose: Brain necrosis or other subacute iatrogenic reactions has been recognized as a potential complication of radiotherapy (RT), although the possible synergistic effects of high-dose chemotherapy and RT might have been underestimated. Methods and Materials: We reviewed the clinical and radiologic data of 49 consecutive children with malignant brain tumors treated with high-dose thiotepa and autologous hematopoietic stem cell rescue, preceded or followed by RT. The patients were assessed for neurocognitive tests to identify any correlation with magnetic resonance imaging (MRI) anomalies. Results: Of the 49 children, 18 (6 of 25 with high-grade gliomas and 12 of 24 with primitive neuroectodermal tumors) had abnormal brain MRI findings occurring a median of 8 months (range, 2-39 months) after RT and beginning to regress a median of 13 months (range, 2-26 months) after onset. The most common lesion pattern involved multiple pseudonodular, millimeter-size, T 1-weighted unevenly enhancing, and T 2-weighted hyperintense foci. Four patients with primitive neuroectodermal tumors also had subdural fluid leaks, with meningeal enhancement over the effusion. One-half of the patients had symptoms relating to the new radiographic findings. The MRI lesion-free survival rate was 74% ± 6% at 1 year and 57% ± 8% at 2 years. The number of marrow ablative courses correlated significantly to the incidence of radiographic anomalies. No significant difference was found in intelligent quotient scores between children with and without radiographic changes. Conclusion: Multiple enhancing cerebral lesions were frequently seen on MRI scans soon after high-dose chemotherapy and RT. Such findings pose a major diagnostic challenge in terms of their differential diagnosis vis-à-vis recurrent tumor. Their correlation with neurocognitive results deserves further investigation.

AB - Purpose: Brain necrosis or other subacute iatrogenic reactions has been recognized as a potential complication of radiotherapy (RT), although the possible synergistic effects of high-dose chemotherapy and RT might have been underestimated. Methods and Materials: We reviewed the clinical and radiologic data of 49 consecutive children with malignant brain tumors treated with high-dose thiotepa and autologous hematopoietic stem cell rescue, preceded or followed by RT. The patients were assessed for neurocognitive tests to identify any correlation with magnetic resonance imaging (MRI) anomalies. Results: Of the 49 children, 18 (6 of 25 with high-grade gliomas and 12 of 24 with primitive neuroectodermal tumors) had abnormal brain MRI findings occurring a median of 8 months (range, 2-39 months) after RT and beginning to regress a median of 13 months (range, 2-26 months) after onset. The most common lesion pattern involved multiple pseudonodular, millimeter-size, T 1-weighted unevenly enhancing, and T 2-weighted hyperintense foci. Four patients with primitive neuroectodermal tumors also had subdural fluid leaks, with meningeal enhancement over the effusion. One-half of the patients had symptoms relating to the new radiographic findings. The MRI lesion-free survival rate was 74% ± 6% at 1 year and 57% ± 8% at 2 years. The number of marrow ablative courses correlated significantly to the incidence of radiographic anomalies. No significant difference was found in intelligent quotient scores between children with and without radiographic changes. Conclusion: Multiple enhancing cerebral lesions were frequently seen on MRI scans soon after high-dose chemotherapy and RT. Such findings pose a major diagnostic challenge in terms of their differential diagnosis vis-à-vis recurrent tumor. Their correlation with neurocognitive results deserves further investigation.

KW - Brain tumors

KW - High-dose chemotherapy

KW - Iatrogenic effects

KW - Magnetic resonance imaging

KW - Neurotoxicity

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