A case report of pseudoprogression followed by complete remission after proton-beam irradiation for a low-grade glioma in a teenager: the value of dynamic contrast-enhanced MRI.
A fourteen years-old boy was treated post-operatively with proton therapy for a recurrent low-grade oligodendroglioma located in the tectal region. Six months after the end of irradiation (RT), a new enhancing lesion appeared within the radiation fields. To differentiate disease progression from radiation-induced changes, dynamic susceptibility contrast-enhanced (DSCE) MRI was used with a T2* sequence to study perfusion and permeability characteristics simultaneously. Typically, the lesion showed hypoperfusion and hyperpermeability compared to the controlateral normal brain. Without additional treatment but a short course of steroids, the image disappeared over a six months period allowing us to conclude for a pseudo-progression. The patient is alive in complete remission more than 2 years post-RT.
Department of Pediatric and Adolescent Oncology, Gustave Roussy Institute, Villejuif, France.
Candice
C
Meyzer
Frédéric
F
Dhermain
Denis
D
Ducreux
Jean-Louis
JL
Habrand
Pascale
P
Varlet
Christian
C
Sainte-Rose
Christelle
C
Dufour
Jacques
J
Grill
D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000532:radiotherapy*; D002648:Child; D003287:Contrast Media; D005910:Glioma / Q000532:radiotherapy*; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy*; D011241:Prednisone / Q000627:therapeutic use; D011522:Protons / Q000009:adverse effects; D011832:Radiation Injuries / Q000175:diagnosis* / Q000188:drug therapy; D011878:Radiotherapy / Q000009:adverse effects
D000893:Anti-Inflammatory Agents; D003287:Contrast Media; D011522:Protons; D011241:Prednisone