Reversible neurotoxicity following hyperfractionated radiation therapy of brain stem glioma

Maye Griebel, Henry S. Friedman, Edward C. Halperin, M. David Wiener, Lawrence Marks, W. Jerry Oakes, John M. Hoffman, G. Robert DeLong, S. Clifford Schold, Beverly Hockenberger, Carolyn R. Freeman, Larry Kun

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


Two patients with brain stem gliomas were treated with hyperfractionated radiation therapy (HFR) (7,020 and 7,560 cGy, respectively). Despite initial clinical improvement during irradiation, both patients demonstrated clinical deterioration approximately 3 weeks after completion of radiotherapy. Cranial magnetic resonance imaging (MRI) revealed a progressive increase in distribution of abnormal brain stem signal consistent with either tumor or edema. 18FDG positron emission tomography (PET) was obtained in one patient and demonstrated a hypermetabolic lesion at diagnosis and a hypometabolic lesion at the time of clinical deterioration postirradiation. Management with a tapering dose of dexametha‐sone alone resulted in marked clinical (both patients) and radiogaphic (one patient) improvement, allowing reduction or discontinuation of this medication. These results suggest that patients with brain stem tumors demonstrating clinical and radiographic evidence of progressive tumor shortly after completion of HFR should be initially managed conservatively with dexamethasone, since these findings may be manifestations of reversible radiation‐related neurotoxicity.

Original languageEnglish (US)
Pages (from-to)182-186
Number of pages5
JournalMedical and Pediatric Oncology
Issue number3
StatePublished - 1991


  • brain stem glioma
  • hyperfractionated irradiation
  • positron emission tomography

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Oncology
  • Cancer Research


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