title: A fatal outcome in a patient with glioblastoma multiforme after receiving high-dose methotrexate.
abstract: The most common adult primary brain tumor is glioblastoma multiforme (GBM). Current treatment is surgical resection, adjuvant radiation and chemotherapy, which can extend the median survival 20-36 weeks (Mansky et al. Central nervous system tumors. In Abraham J, Allegra CJ, Gulley J, eds. Bethesda Handbook of clinical oncology, 2nd edn. Philadelphia, Pennsylvania: Lippincott Williams and Wilkins, 2000: 440-2; Knox S. Intracranial tumors. In Pillot G, Chantler M, Magiera H, Peles S, et al., eds. The Washington Manual Hematology and Oncology Subspecialty Consult. Philadelphia, Pennsylvania: Lippincott Williams and Wilkins, 2004: 204-6.). But treatment efficacy is limited, mandating the exploration of more effective treatments. We report on a patient with GBM treated as per a clinical protocol with high-dose methotrexate (12 g/m(2)), who expired within hours after the initiation of treatment secondary to transtentorial herniation. Although it is not completely clear what caused the patient's herniation, we think that high-dose methotrexate therapy may have played a crucial role. We suggest that high-dose methotrexate should be used cautiously in patients with GBM.
authors.affiliation: West Virginia University Hospitals, One Medical Center Drive, Morgantown, WV 26506, USA. prices@wvuh.com
authors.forename: Samantha
authors.initials: S
authors.lastname: Price
authors.forename: William
authors.initials: W
authors.lastname: Harless
authors.forename: Somi
authors.initials: S
authors.lastname: Rikhye
authors.forename: Ramin
authors.initials: R
authors.lastname: Altaha
mesh_terms: D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D005909:Glioblastoma / Q000188:drug therapy*; D006547:Hernia / Q000209:etiology; D006801:Humans; D007427:Intracranial Pressure / Q000187:drug effects; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D020258:Neurotoxicity Syndromes / Q000209:etiology
chemical_list: D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate