Glioblastoma with brainstem leptomeningeal pseudoprogression following radiation therapy

• Type of Material: Article
• Authors: Nikhar Kinger, Emory University; Michael Hoch, Emory University; Hui-Kuo Shu, Emory University; Brent Weinberg, Emory University
• Language: English
• Date: 2019-05-01
• Publisher: Elsevier
• Publication Version: Final Published Version
• Copyright Statement: © 2019 The Authors
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.radcr.2019.02.015
• Title of Journal or Parent Work: Radiology Case Reports
• ISSN: 1930-0433
• Volume: 14
• Issue: 5
• Start Page: 613
• End Page: 617
• Keywords: Glioblastoma; Leptomeningeal enhancement; Pseudoprogression; Radiation therapy
• Research Categories: Health Sciences, Oncology; Biology, Neuroscience; Health Sciences, Radiology

Abstract

In brain tumor patients, worsening of imaging findings in the first 6 months after surgical debulking and chemoradiation can occur in the absence of tumor growth, a phenomenon known as pseudoprogression. Awareness of pseudoprogression is important as it can lead to unnecessary additional changes in patient management. In this case, a patient with bilateral frontal glioblastoma presented with new post-treatment brainstem leptomeningeal enhancement which was distant from the original tumor site, concerning for disease progression. However, the patient was asymptomatic and correlation of leptomeningeal enhancement locations with radiation therapy dose maps revealed high doses at the affected site, supporting a diagnosis of treatment effect which was confirmed by resolution on follow-up imaging after treatment with steroids. Parenchymal pseudoprogression in brain tumor patients is well-documented, but worsening leptomeningeal enhancement following therapy may also represent treatment effects. If spatially remote leptomeningeal enhancement occurs, correlation with radiation dose maps may be useful in suggesting a diagnosis of treatment effect over tumor progression.