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

Radiation 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 radiochemoth...

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Bibliographic Details
Published in:	BMC cancer Vol. 10; no. 1; p. 520
Main Authors:	Schreiber, Stefanie, Prox-Vagedes, Vanessa, Elolf, Erck, Brueggemann, Ines, Gademann, Guenther, Galazky, Imke, Bartels, Claudius
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 01-10-2010 BioMed Central BMC
Subjects:	Antineoplastic Agents, Alkylating - adverse effects Apoptosis Care and treatment Case Report Case studies Dacarbazine - adverse effects Dacarbazine - analogs & derivatives Development and progression Diabetes Drug Therapy - methods Female Glioblastoma - drug therapy Glioblastoma - metabolism Glioblastoma - radiotherapy Glioblastoma multiforme Health aspects Humans Hypericin Hypericum - adverse effects Hypertension Kinases Magnetic Resonance Imaging - methods Medical imaging Medical treatment Middle Aged Optic Nerve Optic Nerve Diseases - etiology Photodynamic therapy Radiation Radiation Injuries - etiology Radiation Injuries - prevention & control Radiation therapy Radiotherapy Radiotherapy - methods Temozolomide
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Summary:	Radiation 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. The 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. In 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.
ISSN:	1471-2407 1471-2407
DOI:	10.1186/1471-2407-10-520