Combined Intraarterial Carboplatin, Intraarterial Etoposide Phosphate, and IV Cytoxan Chemotherapy for Progressive Optic-Hypothalamic Gliomas in Young Children
Eva Osztiea,
Péter Várallyaya,
Nancy D. Doolittlea,
Cynthia Lacya,
Gary Jonesa,
H. Stacy Nickolsona and
Edward A. Neuwelt
,a
a From the Departments of Neurology (E.O., P.V., N.D.D., C.L., E.A.N.), Radiology (E.O., P.V., G.J.), and Pediatrics (S.N.), Oregon Health Sciences University, Portland, OR.
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FIG 1. Images from the case of a 10-month-old male patient with right eye nystagmus who was diagnosed by CT to have a partly cystic, partly solid, contrast-enhancing chiasmatic glioma (case 1).
A, Contrast-enhanced axial view T1-weighted MR image, obtained after partial resection and three regimens of systemic chemotherapy, shows a strongly contrast-enhancing nodular suprasellar mass with an associated cystic component.
B, After 12 courses of combined intraarterial and IV chemotherapy, the volume of the solid tumor component and the degree of contrast enhancement are significantly decreased. There is no significant change in the volume of cystic component
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FIG 2. Images from the case of a 3-week-old female patient who presented with bilateral rotatory and lateral nystagmus (case 2).
A, Coronal view T1-weighted MR image reveals a solid contrast-enhancing lesion in the territory of the left basal ganglia and corona radiata after two regimens of IV chemotherapy.
B, After six courses of combined intraarterial and IV chemotherapy, there is a significant decrease in the tumor volume and contrast enhancement
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FIG 3. Images from the case of a 6.5-year-old male patient who presented with weight loss and cerebral salt-wasting syndrome (case 3).
A, Axial view T1-weighted MR image, obtained after one course of orally administered chemotherapy, shows an inhomogeneously contrast-enhancing large mass extending into the third ventricle and right temporal lobe. Posteriorly, the tumor fills the entire lumen of the ventricle.
B, Follow-up contrast-enhanced MR image, obtained 6 months after completing 12 courses of combined intraarterial and IV chemotherapy, shows marked shrinkage of the contrast-enhancing lesion (notice the free part of the dorsal third ventricle). A more cystic component is present within the left side of the tumor
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