MR of toxic effects of accelerated fractionation radiation therapy and carboplatin chemotherapy for malignant gliomas.

PURPOSE To present MR findings of parenchymal brain injury after accelerated fractionation radiation therapy combined with carboplatin chemotherapy in the treatment of malignant brain gliomas.

METHODS Eighty-one evaluable subjects in an ongoing treatment protocol for malignant gliomas form the patient base for this report. After surgical resection of tumors, patients underwent a course of accelerated fractionation radiation therapy to a total dose of 60 Gy. Carboplatin was infused intravenously before each radiation treatment. Precontrast and postcontrast MR scans were obtained before treatment and at 4-week intervals afterward and were analyzed retrospectively.

RESULTS Posttreatment MR imaging in 20 of the 81 patients showed development of unusual parenchymal lesions or enlarging masses needing debulking, and these patients underwent second operations. Two groups emerged: those with tumor and necrotic brain (n = 11) and those with necrosis and reactive gliosis but no definitive tumor (n = 9). Enhancing lesions in the tumor-negative group appeared later than those in the tumor-positive group, were often multiple, and were usually located several centimeters away from the tumor resection site or even contralaterally. Common locations were the corpus callosum and corticomedullary junctions. Lesions in the tumor-positive group were more often solitary and located immediately adjacent to the surgical site. Positive and negative results of positron emission tomography with fludeoxyglucose F 18 were obtained in both groups. The incidence of brain necrosis without associated tumor was 11%.

CONCLUSIONS A pattern of unusual enhancing parenchymal brain lesions was seen on MR imaging after accelerated fractionation radiation therapy and concomitant carboplatin chemotherapy. The abnormalities seem more extensive than focal necrotic lesions on enhanced CT or MR imaging after conventional radiation therapy, and they may mimic recurrent tumor.