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Efficacy of temozolomide and bevacizumab for the treatment of leptomeningeal dissemination of recurrent glioblastoma: A case report.

Okita Y, Nonaka M, Umehara T, Kanemura Y, Kodama Y, Mano M, Nakajima S - Oncol Lett (2015)

Bottom Line: Temozolomide (TMZ) is an established therapy for patients with malignant glioma and the standard of care in parenchymal gliomas; however, few reports have been published with regard to its use for the treatment of leptomeningeal dissemination.Only one report has indicated the radiographic response of leptomeningeal dissemination to a TMZ rechallenge, suggesting a potential causative effect.However, five months after the diagnosis of leptomeningeal dissemination the patient succumbed to the disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, Osaka 540-0006, Japan.

ABSTRACT

The prognosis of leptomeningeal dissemination of recurrent glioblastoma is poor, and chemotherapy results in minimal palliative efficacy. Temozolomide (TMZ) is an established therapy for patients with malignant glioma and the standard of care in parenchymal gliomas; however, few reports have been published with regard to its use for the treatment of leptomeningeal dissemination. Only one report has indicated the radiographic response of leptomeningeal dissemination to a TMZ rechallenge, suggesting a potential causative effect. While bevacizumab is an effective therapy for recurrent glioblastoma, its effect on leptomeningeal dissemination of recurrent glioblastoma remains unclear. The present study reports a case of leptomeningeal dissemination of recurrent glioblastoma in which transient neurological and radiological improvement was observed following chemotherapy with TMZ and bevacizumab. However, five months after the diagnosis of leptomeningeal dissemination the patient succumbed to the disease.

No MeSH data available.


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(A, B) MRI showed the progression of leptomeningeal dissemination following one cycle of TMZ and interferon-β therapy. (C, D) Leptomeningeal dissemination on MRI decreased following two cycles of TMZ and one cycle of bevacizumab from the beginning of recurrent therapy. (E, F) MRI showed no progression of leptomeningeal dissemination following three cycles each of TMZ and bevacizumab from the beginning of recurrent therapy. A, C and E: T1-weighted contrast-enhanced MRI; B, D and F: Fluid-attenuated inversion recovery imaging. MRI, magnetic resonance imaging; TMZ, temozolomide.
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f2-ol-09-04-1885: (A, B) MRI showed the progression of leptomeningeal dissemination following one cycle of TMZ and interferon-β therapy. (C, D) Leptomeningeal dissemination on MRI decreased following two cycles of TMZ and one cycle of bevacizumab from the beginning of recurrent therapy. (E, F) MRI showed no progression of leptomeningeal dissemination following three cycles each of TMZ and bevacizumab from the beginning of recurrent therapy. A, C and E: T1-weighted contrast-enhanced MRI; B, D and F: Fluid-attenuated inversion recovery imaging. MRI, magnetic resonance imaging; TMZ, temozolomide.

Mentions: A 28-year-old female with glioblastoma was admitted to the Department of Neurosurgery, Osaka National Hospital (Osaka, Japan) after presenting with diplopia and numbness in the left hand. Magnetic resonance imaging (MRI) revealed an enhanced mass in the right thalamus (Fig. 1A). The tumor was surgically removed, and the histological diagnosis was determined to be glioblastoma. Radiotherapy (60 Gy/30 fr) with concurrent TMZ (75 mg/m2 per day) was administered for a month and a half, following which the patient was discharged from the hospital. A further 24 cycles of outpatient maintenance chemotherapy with TMZ were administered: First cycle, 150 mg/m2; second cycle onwards, 200 mg/m2, for the first five days of each 28-day cycle. No complications or recurrence were observed during maintenance chemotherapy (Fig. 1B). However, two months following the completion of the maintenance TMZ therapy, the patient experienced a seizure and disturbed consciousness. MRI revealed leptomeningeal dissemination in the supra- and infratentorial brain without primary site recurrence (Fig. 1C and D). Cerebrospinal fluid (CSF) cytology specimens were positive for malignant cells. Following one cycle of combined TMZ (150 mg/m2) and interferon-β therapy (3 MU) for the first five days of a 28-day cycle, MRI indicated progression of the leptomeningeal dissemination (Fig. 2A and B).


Efficacy of temozolomide and bevacizumab for the treatment of leptomeningeal dissemination of recurrent glioblastoma: A case report.

Okita Y, Nonaka M, Umehara T, Kanemura Y, Kodama Y, Mano M, Nakajima S - Oncol Lett (2015)

(A, B) MRI showed the progression of leptomeningeal dissemination following one cycle of TMZ and interferon-β therapy. (C, D) Leptomeningeal dissemination on MRI decreased following two cycles of TMZ and one cycle of bevacizumab from the beginning of recurrent therapy. (E, F) MRI showed no progression of leptomeningeal dissemination following three cycles each of TMZ and bevacizumab from the beginning of recurrent therapy. A, C and E: T1-weighted contrast-enhanced MRI; B, D and F: Fluid-attenuated inversion recovery imaging. MRI, magnetic resonance imaging; TMZ, temozolomide.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4356381&req=5

f2-ol-09-04-1885: (A, B) MRI showed the progression of leptomeningeal dissemination following one cycle of TMZ and interferon-β therapy. (C, D) Leptomeningeal dissemination on MRI decreased following two cycles of TMZ and one cycle of bevacizumab from the beginning of recurrent therapy. (E, F) MRI showed no progression of leptomeningeal dissemination following three cycles each of TMZ and bevacizumab from the beginning of recurrent therapy. A, C and E: T1-weighted contrast-enhanced MRI; B, D and F: Fluid-attenuated inversion recovery imaging. MRI, magnetic resonance imaging; TMZ, temozolomide.
Mentions: A 28-year-old female with glioblastoma was admitted to the Department of Neurosurgery, Osaka National Hospital (Osaka, Japan) after presenting with diplopia and numbness in the left hand. Magnetic resonance imaging (MRI) revealed an enhanced mass in the right thalamus (Fig. 1A). The tumor was surgically removed, and the histological diagnosis was determined to be glioblastoma. Radiotherapy (60 Gy/30 fr) with concurrent TMZ (75 mg/m2 per day) was administered for a month and a half, following which the patient was discharged from the hospital. A further 24 cycles of outpatient maintenance chemotherapy with TMZ were administered: First cycle, 150 mg/m2; second cycle onwards, 200 mg/m2, for the first five days of each 28-day cycle. No complications or recurrence were observed during maintenance chemotherapy (Fig. 1B). However, two months following the completion of the maintenance TMZ therapy, the patient experienced a seizure and disturbed consciousness. MRI revealed leptomeningeal dissemination in the supra- and infratentorial brain without primary site recurrence (Fig. 1C and D). Cerebrospinal fluid (CSF) cytology specimens were positive for malignant cells. Following one cycle of combined TMZ (150 mg/m2) and interferon-β therapy (3 MU) for the first five days of a 28-day cycle, MRI indicated progression of the leptomeningeal dissemination (Fig. 2A and B).

Bottom Line: Temozolomide (TMZ) is an established therapy for patients with malignant glioma and the standard of care in parenchymal gliomas; however, few reports have been published with regard to its use for the treatment of leptomeningeal dissemination.Only one report has indicated the radiographic response of leptomeningeal dissemination to a TMZ rechallenge, suggesting a potential causative effect.However, five months after the diagnosis of leptomeningeal dissemination the patient succumbed to the disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Osaka National Hospital, National Hospital Organization, Osaka 540-0006, Japan.

ABSTRACT

The prognosis of leptomeningeal dissemination of recurrent glioblastoma is poor, and chemotherapy results in minimal palliative efficacy. Temozolomide (TMZ) is an established therapy for patients with malignant glioma and the standard of care in parenchymal gliomas; however, few reports have been published with regard to its use for the treatment of leptomeningeal dissemination. Only one report has indicated the radiographic response of leptomeningeal dissemination to a TMZ rechallenge, suggesting a potential causative effect. While bevacizumab is an effective therapy for recurrent glioblastoma, its effect on leptomeningeal dissemination of recurrent glioblastoma remains unclear. The present study reports a case of leptomeningeal dissemination of recurrent glioblastoma in which transient neurological and radiological improvement was observed following chemotherapy with TMZ and bevacizumab. However, five months after the diagnosis of leptomeningeal dissemination the patient succumbed to the disease.

No MeSH data available.


Related in: MedlinePlus