Summary
Eight cases of cerebral cyst formation among 50 patients (= 16%) with malignant supratentorial gliomas treated by surgery, megavoltage radiation, and multiple-agent chemotherapy are reported. Five of them developed signs of intracranial hypertension or progressive neurological deficit, while in three patients cerebral cysts were detected by CT without clinical deterioration. At operation or autopsy, or both, the large fluid-filled, smooth-walled cysts were lined by glio-mesenchymal scar tissue with no or little tumour recurrence in five, while three patients showed large recurrent tumour masses associated with necrosis and cyst formation. Clinical signs or CT evidence, or both, of cerebral cysts developed 4 to 12 months (average 10 months) after the first craniotomy, and 3 to 9 months after termination of radiotherapy, usually after the second to fourth course of polychemotherapy. The cystic cavities which are attributed to increased necrosis and other effects of radiation and cytostatic treatment, may mimic tumour progression or recurrence, and cerebral abscess, but are usually recognized by CT. Surgical treatment produced transient clinical improvement in 5 patients, but usually did not prevent the fatal outcome of the disease, which in these patients occurred 3 weeks to 6 months after surgical treatment of cyst formation, their life span ranging from 9 to 22 months. The pathogenesis and clinical problems related to cerebral cysts arising following multimodality treatment of malignant brain tumours are discussed.
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Asbury, A. K., Ojemann, R. G., Nielsen, S. L., Sweet, W. H., Neuropathologic study of 14 cases of malignant brain tumor treated by boron-10 slow neutron capture radiation. J. Neuropath, exp. Neurol.31 (1972), 278–302.
Breuer, A. C., Blank, N. K., Schoene, W. C., Multifocal pontine lesions in cancer patients treated with chemotherapy and CNS radiotherapy. Cancer41 (1978), 2112–2220.
Brismar, J., Robertson, G. H., Davis, K. R., Radiation necrosis of the brain. Neuroradiological considerations with computed tomography. Neuroradiol.12 (1976), 109–113.
Burger, P. C., Mahaley, M. S., Jr., Dudka, L., Vogel, F. S., The morphologic effects of radiation administered therapeutically for intracranial gliomas. Cancer44 (1979), 1256–1272.
Catterall, M., Bloom, H. J. G., Ash, D. V., Walsh, L., Richardson, A., Gowing, N. F. C., Lewis, P., Chaucer, B., Fast neutrons compared with megavoltage X-rays in the treatment of patients with supratentorial glioblastoma: a controlled pilot study. Int. J. Rad. Oncol. Biol. Phys.6 (1980), 261–266.
Eyster, E. F., Nielsen, S. L., Sheline, G. E., Wilson, C. B., Cerebral radiation necrosis simulating brain tumor. J. Neurosurg.39 (1974), 267–271.
Gerstner, L., Jellinger, K., Heiss, W.-D., Wöber, G., Cytological changes in anaplastic gliomas following radiation and chemotherapy. Acta neurochir. (Wien)36 (1977), 117–138.
Hatanaka, H., A revised boron-neutron capture therapy for malignant brain tumors. J. Neurol.209 (1975), 81–94.
Haymaker, W., Effects of ionizing radiation on nervous tissue. In: The structure and function of nervous tissue, Vol. 3, pp. 441–518. New York: Academic Press. 1969.
Heiss, W. D., Turnheim, M., Mamoli, B., Combination chemotherapy of malignant glioma. Effect of postoperative treatment with CCNU, vincristine, amethopterine and procarbazine. Europ. J. Cancer14 (1978), 1191–1202.
Hildebrand, J., Brihaye, J., Chemotherapy of brain tumors. In: Advances and technical standards in neurosurgery, Vol. 5, pp. 52–91 (Krayenbühl, H., ed.). Wien-New York: Springer. 1978.
Holdorff, B., Radiation damage to the brain. In: Handbook of clinical neurology, Vol. 23, pp. 639–663. Amsterdam: North Holland Publ. Comp. 1975.
Jänisch, W., Güthert, H., Schreiber, D., Pathologie der Tumoren des Zentralnervensystems. Jena: G. Fischer. 1976.
Jellinger, K., Human central nervous system lesions following radiation therapy. Zbl. Neurochir.38 (1977), 199–220.
Jellinger, K., Glioblastoma multiforme: morphology and biology. Acta neurochir. (Wien)42 (1978), 5–32.
Jellinger, K., Kothbauer, P., Volc, D., Vollmer, R., Weiss, R., Combination polychemotherapy (COMP protocol) and radiotherapy of anaplastic supratentorial gliomas. Acta neurochir. (Wien)51 (1979), 1–13.
Jellinger, K., Volc, D., Podreska, I., Grisold, W., Flament, H., Vollmer, R., Weiss, R., Ergebnisse der Kombinationsbehandlung maligner Gliome. Nervenarzt52 (1981), 41–50.
Kothbauer, P., Jellinger, K., Flament, H., Primary brain tumor presenting as spontaneous intracerebral haemorrhage. Acta neurochir. (Wien)49 (1979), 35–45.
Kramer, S., Lee, K. F., Complications of radiation therapy: The central nervous system. Semin. Roentgenol.9 (1974), 75–83.
Laramore, G. E., Griffin, T. W., Gerdes, A. J., Parker, R. G., Fast neutron and mixed (neutron/photon) beam teletherapy for grades III and IV astrocytomas. Cancer42 (1978), 96–103.
Leenhouts, H. P., Chadwick, K. H., Deen, D. F., An analysis of the interaction between two nitrosurea compounds and X-radiation in rat brain tumor cells. Int. J. Radiat. Biol.37 (1980), 169–181.
Lieberman, A., Ransohoff, J., Treatment of primary brain tumors. Med. Clin. N. Amer.63 (1979), 835–848.
Littman, P., James, H., Zimmerman, R., Slater, R., Radionecrosis of the brain presenting as a mass lesion. J. Neurol. Neurosurg. Psychiat.40 (1977), 827–829.
Mennel, H. D., Heiss, W.-D., Chemotherapie des Hirntumors: Grundsätze, Schwierigkeiten, Möglichkeiten und Strategien. Wien. klin. Wschr.92 (1980), 591–602.
Mikhael, M. M., Radiation necrosis of the brain: Correlation between computed tomography, pathology and dose distribution. J. Comput. Ass. Tomogr.2 (1978), 71–80.
Nakagaki, H., Branhart, G., Kemper, T. L., Cavenness, W. F., Monkey brain damage from radiation in the therapeutic range. J. Neurosurg.44 (1976), 3–11.
Nakamura, N., Ogawa, H., Kumanishi, T., Pathological investigation of radiation necrosis. Complete necrosis of brain tumors observed in autopsy cases. Neurol. Surg.2 (1974), 213–220.
Paillas, J. E., Prince, M. A., Hassoun, J., Pellet, W., Peragut, J. C., L'apport de la chimiothérapie au traitement conventionnel des gliomes malins du cerveau. Rev. Neurol. (Paris)135 (1979), 251–262.
Paoletti, P., Walker, M. D., Butti, G., Knerich, R. (eds.), Multidisciplinary aspects of brain tumor therapy. Amsterdam-New York-Oxford: Elsevier-North Holland Biomedical Press. 1979.
Poisson, M., Hauw, J. J., Pouillart, P., Bataini, J. P., Mashaly, R., Pertuiset, B. F., Metzger, J., Malignant gliomas treated after surgery by combination chemotherapy and delayed radiation therapy. II. Tolerance to irradiation after chemotherapy. Acta neurochir. (Wien)51 (1979), 27–42.
Poisson, M., Philippon, J., van Effenterre, R.,et al., Cerebral pseudocysts following chemotherapy of glioblastomas. Acta neurochir. (Wien)39 (1977), 143–149.
Poisson, M., Pouillart, P., Bataini, J. P., Mashaly, R., Pertuiset, B. F., Metzger, J., Malignant gliomas treated after surgery by combination chemotherapy and delayed irradiation. I. Analysis of results. Acta neurochir. (Wien)31 (1979), 15–25.
Queiroz, de, L. S. P., Cruz Nato, J. N., Late pseudotumoral brain necrosis following irradiation of scalp neoplasm. J. Neurosurg.45 (1976), 581–584.
Reuck, de, J., van der Eecken, H., The anatomy of the late radiation encephalopathy. Eur. Neurol.13 (1975), 481–494.
Rubinstein, L. J., Pathology of the tumors of the central nervous system. Atlas of tumor pathology, Fasc. VII, 2nd ed. Washington: Armed Forces Institute of Pathology. 1972.
Rubinstein, L. J., Herman, M. N., Long, T. F., Wilbur, J. R., Disseminated necrotizing leukoencephalopathy: A complication of treated central nervous system leukemia and lymphoma. Cancer35 (1975), 291–305.
Salazar, O. M., Rubin, P., Feldstein, M. L., Pizzutiello, R., High dose radiation therapy in the treatment of malignant gliomas. Final report. Int. J. Radiat. Oncol. Biol.-Phys.5 (1979), 1733–1740.
Schiffer, D., Giordana, M. T., Paoletti, P., Soffietti, R., Tarenzi, L., Pathology of human malignant gliomas after radiation and chemotherapy. Acta neurochir. (Wien)53 (1980), 205–216.
Shaw, C.-M., Sumi, M., Alvord, E. C., Jr., Gerdes, A. J., Spence, A., Parker, R. G., Fast-neutron irradiation of glioblastoma multi forme. J. Neurosurg.49 (1978), 1–12.
Steinbok, P., Mahaley, M. S., Raymond, U., Zinn, D. C., Lipper, S., Mahaley, J. L., Bigner, D. D., Synergism between BCNU and irradiation in the treatment of anaplastic gliomas. J. Neurosurg.51 (1979), 581–586.
Steinbok, P., Mahaley, M. S., Mahesh, R. U., Lipper, S., Mahaley, J., Dalzell, J. G., Bigner, D. D., Treatment of autochthonous rat brain tumors with fractionated radiotherapy. J. Neurosurg.53 (1980), 68–72.
Steinhoff, H., Lanksch, W., Kazner, E., Grumme, T., Meese, W., Lange, S., Aulich, A., Schindler, E., Wende, S., Computed tomography in the diagnosis and differential diagnosis of glioblastomas. Neuroradiol.14 (1977), 192–200.
Thomas, D. G. T., Graham, D. I. (eds.), Brain tumours. Scientific basis, clinical investigation and current therapy. London-Boston: Butterworths. 1980.
Walker, M. D., Green, S. B.,et al., Randomized comparisons of radiotherapy and nitrosureas for the treatment of malignant glioma after surgery. New Engl. J. Med.303 (1980), 1323–1329.
Willson, C. B., Duffy, P. E., Morphologic changes associated with combined BCNU and radiation therapy in glioblastoma multiforme. Neurology24 (1974), 465–471.
Zeman, W., The effects of atomic radiations. In: Pathology of the nervous system, Vol. 1, pp. 864–939 (Minckler, J., ed.). New York: McGraw-Hill. 1968.
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Volc, D., Jellinger, K., Flament, H. et al. Cerebral space-occupying cysts following radiation and chemotherapy of malignant gliomas. Acta neurochir 57, 177–193 (1981). https://doi.org/10.1007/BF01664836
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DOI: https://doi.org/10.1007/BF01664836