Bilateral posterior RION after concomitant radiochemotherapy with temozolomide in a patient with glioblastoma multiforme: a case report

Schreiber, Stefanie; Prox-Vagedes, Vanessa; Elolf, Erck; Brueggemann, Ines; Gademann, G.; Galazky, Imke; Bartels, Claudius

doi:10.1186/1471-2407-10-520

Cited by 8 publications

(10 citation statements)

References 24 publications

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“…Bhandare, Demizu and Parsons identified potential risk factors by isolating a rare few cases from prospective cohorts of hundreds receiving EBRT. Schreiber and Girkin suggest potential risk factors from retrospective case reports of individual patients.…”

Section: Discussionmentioning

confidence: 99%

“…These have described potentially predisposing factors for RION according to plausible pathogenic mechanisms. 3,[12][13][14] Demizu et al found a significant association for diabetes mellitus. 15 Deng et al suggested that compression of the optic nerve by tumour may sensitize the visual pathway to radiation injury.…”

Section: Introductionmentioning

confidence: 98%

“…Those that do consider patient‐associated attributes have been descriptive case reports, case series and reviews. These have described potentially predisposing factors for RION according to plausible pathogenic mechanisms . Demizu et al found a significant association for diabetes mellitus .…”

Section: Introductionmentioning

confidence: 99%

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Risk factors for radiation‐induced optic neuropathy: a case–control study

Ferguson

Huecker

Huang

et al. 2017

Clinical Exper Ophthalmology

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Importance Identifying risk factors for RION could promote a more conservative approach to radiation treatment planning in vulnerable patients. Background This study explored possible factors beyond radiation dose associated with the development of radiation-induced optic neuropathy (RION) after external beam radiation therapy. Design This was a retrospective case-control study conducted at a university hospital tertiary care center. Participants Cases (n=14) meeting criteria for a diagnosis of RION by neuro- ophthalmologic exam were identified from a single-center neuro-ophthalmology database. Controls (n=31) without RION were selected from a single-center radiation oncology database. Methods Controls were matched to cases based upon maximum radiation dose to the optic apparatus. Patient characteristics and treatment parameters were interrogated by univariate analysis for attributes predisposing to RION. Main Outcome Measures The primary parameter was a significant association of patient characteristics or treatment parameters with RION. Results Controlling for radiation dosage, no significant associations for alternative risk factors were identified. Conclusions and Relevance These results support the literature suggesting that the primary risk factor for developing RION is radiation dosage and that additional, patient- and tumor-related risk factors may play only a minor role.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

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Risk factors for radiation‐induced optic neuropathy: a case–control study

Ferguson

Huecker

Huang

et al. 2017

Clinical Exper Ophthalmology

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“…Most of these cases were reported to have associated severe absolute lymphopenia and low CD4 + T-cell count. Three other cases with a very rare toxicity have been mentioned in Table 1 [49][50][51].…”

Section: Uncommon Infectionmentioning

confidence: 95%

Temozolomide-related idiosyncratic and other uncommon toxicities

Dixit

Baker²,

Walmsley³

et al. 2012

Anti-Cancer Drugs

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Temozolomide (TMZ)-related idiosyncratic and other uncommon toxicities have been reported. To better characterize these toxicities and to identify any associated risk factors, we performed a systematic review. We searched the PubMed database, limited to the English language, published between 1999 and December 2011. We selected only those articles in which TMZ was temporally related and was the sole or main contributing chemotherapeutic drug to idiosyncratic drug reactions (IDRs) and other uncommon toxicities. Hematological IDRs are biopsy-proven aplastic anemia or grade V toxicity or grade IV toxicity with slow and incomplete hematological recovery. Seventy-three cases were identified, including 21 hematological IDRs, 31 nonhematological IDRs and uncommon infections, and 21 second primary cancers. With a caveat of publication and reporting bias, the following observations could be made. The hematological IDRs predominantly occurred in female patients (exact binomial two-tailed, P=0.0041) and most patients were receiving TMZ concomitantly with radiotherapy for glioma. The median duration of exposure to TMZ was 30 days and the median cumulative TMZ exposure was 2250 mg/m (range, 500-6900 mg/m). The sex predilection was not evident in nonhematological IDRs and other uncommon toxicities. TMZ-induced pneumonitis and cholestatic hepatitis are emerging as a nonhematological hypersensitive reaction and IDR, respectively. For TMZ-related myelodysplasia or leukemia, the cumulative dose of TMZ ranged from 1400 to 30 000 mg/m. The cumulative dose of TMZ was lower and latency was shorter with a previous exposure to other leukemogenic drugs, suggesting that TMZ may have augmented the leukemogenic potential of other drugs. Early appearance of profound myelosuppression during the course of TMZ and concurrent radiotherapy could be a hematological IDR, which warrants prompt investigations to exclude aplastic anemia. Myelodysplasia or leukemia developed after a median TMZ exposure of 15 g/m.

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“…11,12 Bilateral RON has been described in glioblasotma patients receiving bevacizumab as well as after radio-sensitisation by temozolomide. 13,14 Development of RON in our patient could be due to radiation alone; however, there is a possibility of radio-sensitisation with temozolomide.…”

Section: Discussionmentioning

confidence: 75%

Bilateral Radiation Optic Neuropathy Following Concurrent Chemotherapy and Radiation in Glioblastoma

Thakkar

Slevin

Smith

et al. 2017

Neuro-Ophthalmology

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Radiation optic neuropathy (RON) is an iatrogenic complication that causes severe, irreversible vision loss within months to years following radiation to lesions close to the visual pathway. The authors describe a case of RON in glioblastoma after radio-sensitisation with temozolomide with sequential involvement of both optic nerves. This case provides a timeline for clinical and imaging findings with RON and specifically resolution of nerve enhancement. The authors also highlight the potential of an increase in incidence of RON in glioblastoma with advances in survival seen with greater use of second-line chemotherapy and even re-radiation.

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Bilateral posterior RION after concomitant radiochemotherapy with temozolomide in a patient with glioblastoma multiforme: a case report

Cited by 8 publications

References 24 publications

Risk factors for radiation‐induced optic neuropathy: a case–control study

Risk factors for radiation‐induced optic neuropathy: a case–control study

Temozolomide-related idiosyncratic and other uncommon toxicities

Bilateral Radiation Optic Neuropathy Following Concurrent Chemotherapy and Radiation in Glioblastoma

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