Pontine glioma treated with radiochemotherapy

A case of pontine glioma is reported with long-term follow-up positron emission tomography (PET) studies of regional cerebral blood flow and metabolism following radiochemotherapy. A 14-year-old girl presented with double vision and gait disturbance. X-ray computed tomography (CT) revealed a low density area without contrast enhancement in the pontine region. On the basis of CT and neurological findings, she was clinically diagnosed as a pontine glioma, inaccessible to surgery. Radiochemotherapy was given as follows: 32 Gy in 16 fractions to the whole brain, an additional 28 Gy in 14 fractions to the tumor site, and chemotherapy using ACNU and FT-207 were done. Regions of interest (ROI) were placed over the eleven anatomical portions including gray matter, white matter, and subcortical nuclei. As compared with the pretreatment study, rCBF, rCBV, and rCMRO2 increased in all regions one month after the completion of radiotherapy; however, the indeces inversely fell one year thereafter. On the other hand, changes in rCMRGl were not similar to those of rCMRO2, especially in the early study. Two years later, hemodynamics and oxygen and glucose metabolism again increased, suggesting a recovery from hemocirculatory and metabolic perturbation of the irradiated brain. These results indicate that PET studies may be a good way to monitor the adverse effect of radiochemotherapy on the brain tissue. (author)