Brain magnetic resonance imaging after high-dose chemotherapy and radiotherapy for childhood brain tumors.
OBJECTIVE
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
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, T1-weighted unevenly enhancing, and T2-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.


CONCLUSIONS
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.
Spreafico
Filippo
F
Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. filippo.spreafico@istitutotumori.mi.it
Gandola
Lorenza
L
Marchianò
Alfonso
A
Simonetti
Fabio
F
Poggi
Geraldina
G
Adduci
Anna
A
Clerici
Carlo Alfredo
CA
Luksch
Roberto
R
Biassoni
Veronica
V
Meazza
Cristina
C
Catania
Serena
S
Terenziani
Monica
M
Musumeci
Renato
R
Fossati-Bellani
Franca
F
Massimino
Maura
M
D000293:Adolescent; D000328:Adult; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001921:Brain / Q000187:drug effects / Q000473:pathology / Q000528:radiation effects; D001932:Brain Neoplasms / Q000188:drug therapy / Q000532:radiotherapy; D002648:Child; D002675:Child, Preschool; D003071:Cognition / Q000187:drug effects / Q000528:radiation effects; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D005910:Glioma / Q000188:drug therapy / Q000532:radiotherapy; D006801:Humans; D007223:Infant; D007360:Intelligence / Q000187:drug effects / Q000528:radiation effects; D008279:Magnetic Resonance Imaging; D008297:Male; D008527:Medulloblastoma / Q000188:drug therapy / Q000532:radiotherapy; D018242:Neuroectodermal Tumors, Primitive / Q000188:drug therapy / Q000532:radiotherapy; D013852:Thiotepa / Q000008:administration & dosage / Q000009:adverse effects*
D018906:Antineoplastic Agents, Alkylating; D013852:Thiotepa