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Brain stem necrosis after preradiation high-dose methotrexate

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Abstract

Both cranial radiation therapy (RT) and high-dose systemic methotrexate (MTX) are used to treat intracranial neoplasms, but both may cause neurologic damage. MTX may be less neurotoxic if given before rather than after radiotherapy. We cared for a 5-year-old girl with a pineocytoma who had progressive brain stem dysfunction 4 months after MTX therapy, followed by local radiation therapy. CT studies were consistent with radiation necrosis that was confirmed at autopsy. MTX used in conjunction with cranial irradiation can result in severe neurotoxicity, even if the drug is given first.

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Authors and Affiliations

  1. Division of Child Neurology, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, 19104, Philadelphia, PA, USA

    Roger J. Packer

  2. Division of Neuropathology, Children's Hospital of Philadelphia, 19104, Philadelphia, PA

    Lucy B. Rorke

  3. Division of Neurosurgery, Children's Hospital of Philadelphia, 19104, Philadelphia, PA

    Leslie N. Sutton

  4. Division of Oncology, Children's Hospital of Philadelphia, 19104, Philadelphia, PA

    Kathy R. Siegel

  5. Department of Neurology, University of Pennsylvania Medical School, Philadelphia, PA, USA

    Roger J. Packer

  6. Department of Pediatrics, University of Pennsylvania Medical School, Philadelphia, PA, USA

    Roger J. Packer

  7. Department of Neuroradiology, University of Pennsylvania Medical School, Philadelphia, PA, USA

    Robert I. Grossman

  8. Department of Neuropathology, University of Pennsylvania Medical School, Philadelphia, PA, USA

    Lucy B. Rorke

  9. Department of Radiation Therapy, University of Pennsylvania Medical School, Philadelphia, PA, USA

    Phillip Littman

Authors
  1. Roger J. Packer
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  2. Robert I. Grossman
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  3. Lucy B. Rorke
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  4. Leslie N. Sutton
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  5. Kathy R. Siegel
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  6. Phillip Littman
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Packer, R.J., Grossman, R.I., Rorke, L.B. et al. Brain stem necrosis after preradiation high-dose methotrexate. Child's Nerv Syst 1, 355–358 (1985). https://doi.org/10.1007/BF00270824

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