Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2022, 166(2):236-241 | DOI: 10.5507/bp.2021.012

Very late complications of oncotherapy in glioblastoma patients: A case series

Ondrej Kalitaa, Lumir Hrabaleka, Matej Halaja, Pavel Hokb, David Francb, Yvona Klementovac, Martin Dolezelc, Eva Cechakovad, Zuzana Sporikovae, Jiri Drabeke, Marian Hajduche, Lucie Tuckovaf
a Department of Neurosurgery, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
b Department of Neurology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
c Department of Oncology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
d Department of Radiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
e Laboratory of Experimental Medicine, Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
f Department of Pathology and Laboratory of Molecular Pathology, Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic

Background: Stroke-like syndrome is defined as a rare, delayed complication of brain oncotherapy. Cases with more favorable brain cancer diagnoses and longer life expectancy have been previously reported, but here we present, for the first time, three long-term survivors of glioblastoma with stroke-like syndromes.

Methods and Results: Three young or middle-aged patients underwent tumor resection and chemoradiotherapy. They received regular clinical and imaging follow-up with stable neurological status and no signs of tumor recurrence. They exhibited varied signs and symptoms (motor and sensory deficits, aphasia, memory and cognitive disorders, seizures, and headache) accompanied by imaging abnormalities. Stroke-like syndromes developed within 2-5 days and resolved in 2-6 weeks. Diffusion-weighted MRI and T2 brain perfusion abnormalities were demonstrated in all patients. In addition, there was focal T1 MRI contrast enhancement due to blood-brain barrier disruption. In addition to tumor recurrence, classic stroke, encephalitis, metabolic and mitochondrial disorders, and post-seizure swelling should be excluded. The imaging indicated intensive MRI scanning and symptomatic medication (steroids supplemented by antiepileptics, vasoactive agents, etc.) for judicious management. With respect to the course, an invasive procedure was still considered an option.

Conclusion: All stroke-like syndromes are diagnoses of exclusion. To avoid misinterpretation of imaging findings as glioblastoma recurrence and avert recall oncotherapy or redundant interventions, better understanding of delayed complications of brain tumor therapy is crucial.

Keywords: stroke-like syndrome, glioblastoma, oncotherapy, corticosteroid

Received: November 28, 2020; Revised: January 14, 2021; Accepted: January 29, 2021; Prepublished online: February 22, 2021; Published: May 13, 2022  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Kalita, O., Hrabalek, L., Halaj, M., Hok, P., Franc, D., Klementova, Y., ... Tuckova, L. (2022). Very late complications of oncotherapy in glioblastoma patients: A case series. Biomedical papers, 166(2), 236-241. doi: 10.5507/bp.2021.012
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Sheikh S, Radivoyevitch T, Barnholtz-Sloan JS, Vogelbaum M. Long-term trends in glioblastoma survival: implications for historical control groups in clinical trials. Neuroocol Pract 2020;7(2):158-63. Go to original source... Go to PubMed...
    2. Lim SY, Brooke J, Dineen R, O'Donoghue M. Stroke-like migraine attack after cranial radiation therapy: the SMART syndrome. Pract Neurol 2016;16(5):406-8. Go to original source... Go to PubMed...
    3. Di Stefano AL, Berzero G, Ducray F, Eoli M, Pichiecchio A, Farina LM, Cuccarini V, Brunelli MC, Diamanti L, Condette Auliac S, Salmaggi A, Silvani A, Giometto B, Pace A, Vidiri A, Bourdain F, Bastianello S, Ceroni M, Marchioni E. Stroke-like events after brain radiotherapy: a large series with long-term follow-up. E. Eur J Neurol 2019;26(4):639-50. Go to original source... Go to PubMed...
    4. Di Stefano AL, Berzero G, Vitali P, Galimberti CA, Ducray F, Ceroni M, Bastianello S, Colombo AA, Simoncelli A, Brunelli MC, Giometto B, Diamanti L, Gaviani P, Salmaggi A, Silvani A, Marchioni E. Acute late-onset encephalopathy after radiotherapy: an unusual life-threatening complication. Neurology 2013;81:1014-7. Go to original source... Go to PubMed...
    5. Urbanovska I, Houdova Megova M, Kalita O, Uvirova M, Simova J, Tuckova L, Buzrla P, Palecek T, Hajduch M, Dvorackova J, Drabek J. IDH1 mutation analysis by CADMA compared with SNaPshot assay and two immunohistochemical methods. Pathol Oncol Res 2019;25(3):971-78. Go to original source... Go to PubMed...
    6. Biju RK, Dower A, Moon BG, Gan P. SMART (Stroke-Like Migraine Attacks After Radiation Therapy) syndrome: A case study with imaging supporting the theory of vascular dysfunction. Am J Case Rep 2020;28;21:e921795. Go to original source... Go to PubMed...
    7. Stupp R, Hegi ME, Mason WP, et van den Bent MJ, Taphoorn MJ, Janzer RC, Ludwin SK, Allgeier A, Fisher B, Belanger K, Hau P, Brandes AA, Gijtenbeek J, Marosi C, Vecht CJ, Mokhtari K, Wesseling P, Villa S, Eisenhauer E, Gorlia T, Weller M, Lacombe D, Cairncross JG, Mirimanoff RO; European Organisation for Research and Treatment of Cancer Brain Tumour and Radiation Oncology Groups; National Cancer Institute of Canada Clinical Trials Group. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol 2009;10:459-66. Go to original source... Go to PubMed...
    8. Wen PY, Weller M, Lee EQ, Alexander BM, Barnholtz-Sloan JS, Barthel FP, Batchelor TT, Bindra RS, Chang SM, Chiocca EA, Cloughesy TF, DeGroot JF, Galanis E, Gilbert MR, Hegi ME, Horbinski C, Huang RY, Lassman AB, Le Rhun E, Lim M, Mehta MP, Mellinghoff IK, Minniti G, Nathanson D, Platten M, Preusser M, Roth P, Sanson M, Schiff D, Short SC, Taphoorn MJB, Tonn JC, Tsang J, Verhaak RGW, von Deimling A, Wick W, Zadeh G, Reardon DA, Aldape KD, van den Bent MJ. Glioblastoma in adults: A Society for Neuro-Oncology (SNO) and European Society of Neuro-Oncology (EANO) consensus review on current management and future directions. Neuro Oncol 2020;22(8):1073-113. Go to original source... Go to PubMed...
    9. Black DF, Morris JM, Lindell EP, Krecke KN, Worrell GA, Bartleson JD, Lachance DH. Stroke-like migraine attacks after radiation therapy (SMART) syndrome is not always completely reversible: a case series. Am J Neuroradiol 2013;34(12):2298-303. Go to original source... Go to PubMed...
    10. Wilke C, Grosshans D, Duman J, Brown P, Li J. Radiation-induced cognitive toxicity: pathophysiology and interventions to reduce toxicity in adults. Neuro Oncol 2018;20(5):597-607. Go to original source... Go to PubMed...

    This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits use, distribution, and reproduction in any medium, provided the original publication is properly cited. No use, distribution or reproduction is permitted which does not comply with these terms.


    Return to the content