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

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

doi:10.1186/1471-2407-10-520

Stefanie Schreiber, Claudius Bartels + Show 5 more

Open Access

https://doi.org/10.1186/1471-2407-10-520

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Abstract

BackgroundRadiation induced optic neuropathy (RION) is a rare but severe consequence of radiation therapy that is associated with adjuvant chemotherapy, specifically therapy with vincristine or nitrosoureas. However, there is very little evidence regarding the occurrence of RION after concomitant radiochemotherapy with temozolomide.Case PresentationThe case of a 63 year old woman with glioblastoma multiforme and concomitant radiochemotherapy with temozolomide is described. Due to a slight depressive episode the patient also took hypericum perforatum. Five months after cessation of fractionated radiation and adjuvant chemotherapy with temozolomide (cumulative dose of 11040 mg) the patient developed bilateral amaurosis due to RION. Tumor regrowth was excluded by magnetic resonance imaging. After the application of gadolinium a pathognomonic contrast enhancement of both prechiasmatic optic nerves could be observed.ConclusionsIn this patient, the occurrence of RION may have been the result of radiosensitization by temozolomide, which could have been strengthened by hypericin. Consequently, physicians should avoid a concomitant application of hypericum perforatum and radiochemotherapy.

Highlights

Radiation induced optic neuropathy (RION) is a rare but severe consequence of radiation therapy that is associated with adjuvant chemotherapy, therapy with vincristine or nitrosoureas
In this patient, the occurrence of RION may have been the result of radiosensitization by temozolomide, which could have been strengthened by hypericin
Physicians should avoid a concomitant application of hypericum perforatum and radiochemotherapy

Summary

Conclusions

5 months after cessation of concomitant radiochemotherapy with temozolomide. An intrinsic mass in the optic nerves and/or chiasm was excluded by MRI, as was a compression of those structures by a possible recurrence of the tumor. Gadolinium enhancement of the optic nerve anywhere from its extraocular-intraorbital part to the optic chiasm seems to Figure 3 Images 5 months after cessation of radiation. An inhibition or cleavage of PARP might enhance the cytotoxicity of temozolomide [17] and might lead to radiosensitization [18] at least in the case of tumorcells To what extent these processes take place in the healthy tissue of the optic nerves and the chiasm has not been determined. In view of the case of bilateral RION we report, and the aforementioned possible connection between St. John’s wort and both temozolomide and the effects of radiation, physicians should be careful about administering hypericin simultaneously with radiochemotherapy. The patient’s son has consented to publishing the data

Background

Findings

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