P01.162 Radiation-induced glioblastoma long survivor: Case report

Abstract

BACKGROUND: Gliomas induced by radiation therapy are unusual and present an aggressive behavior and poor prognosis. They can occur as a side-effect of radiation even several decades after the treatment. They are more frequent in young people who suffered acute lymphoblastic leukemia in their childhood and were treated with prophylactic whole brain irradiation. We report the case of a patient diagnosticated of glioblastoma sixteen years after of being treated by radiotherapy for a no-Hodgkin lymphoma. MATERIAL AND METHODS: A 21-year-male, presented with clinical onset of intense headache on the right side. Neurological examination revealed nothing abnormal. He had a history of no-Hodgkin lymphoma successfully treated 15 years ago by intrathecal chemotherapy, craniospinal radiotherapy (total dose 14 Gy) and autologous bone marrow transplant. We performed a cranial tomography and magnetic resonance imaging showing a right temporal lesion with perilesional edema and contrast enhancement, suggesting a highgrade glioma. RESULTS: Due to his previous history, we initially performed a stereotactic biopsy. As histopathological study revealed glioblastoma multiforme, 15 days after we performed a pterional craniotomy and the lesion was totally removed. The lesion presented necrosis and high vascularization and we implanted 6 carmustine wafers in the surgical field. Histologic examination confirmed the diagnosis of glioblastoma. Genetic analysis performed years later did not detect any mutation on the IDH1/2 gene. The integrated diagnosis was IDH wild-type glioblastoma. The postoperative period was uneventful, and the patient was discharged on the ffth postoperative day. He was after treated with systemic chemotherapy with temozolomide and cranial radiotherapy. 9 years after the surgery, the patient is alive and asymptomatic. The last cranial magnetic resonance imaging performed shows no evidence of tumor recurrence. CONCLUSION: Patients with a history of cranial radiotherapy must undergo systematic, long-term surveillance for early detection of intracranial neoplasms. Though rare, gliomas may represent a serious late complication of radiation treatment. As they have previously been treated with radiotherapy, the therapeutic tools are more limited. The treatment should be complete surgical removal of the tumor followed by systemic chemotherapy and cranial radiotherapy only when possible.