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Fatal brain stem necrosis after standard posterior fossa radiation and aggressive chemotherapy for metastatic medulloblastoma
Author(s) -
Watterson Jan,
Simonton Susan C.,
Rorke Lucy B.,
Packer Roger J.,
Kim Tae H.,
Spiegel Ronald H.,
Priest John R.
Publication year - 1993
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(19930615)71:12<4111::aid-cncr2820711250>3.0.co;2-4
Subject(s) - medicine , medulloblastoma , ataxia , chemotherapy , radiation therapy , cyclophosphamide , surgery , autopsy , pathology , psychiatry
A 3‐year‐old girl received conventional‐dose external beam posterior fossa irradiation (5400 cGy in 30 fractions over 40 days) for good‐risk medulloblastoma. Soon thereafter, she experienced an extraneural (occipital scar, cervical lymph nodes) and central nervous system (CNS) recurrence. Intensive cisplatin and cyclophosphamide chemotherapy led to rapid disappearance of the extraneural disease. Methotrexate was administered via a ventricular reservoir. After 2 months of chemotherapy, CNS toxicity progressed rapidly from ataxia to paraplegia to quadriplegia to central respiratory failure. Radiographic scans and autopsy material revealed brain stem necrosis. This unusual toxicity raises concern about the safety of aggressive systemic chemotherapy and intrathecal therapy, when given after conventional radiotherapy.