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Related Experiment Videos

Brain stem necrosis after preradiation high-dose methotrexate.

R J Packer, R I Grossman, L B Rorke

    Child'S Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery
    |January 1, 1985
    PubMed
    Summary

    High-dose methotrexate (MTX) and cranial radiation therapy (RT) can cause severe neurotoxicity in children with brain tumors. Even when MTX precedes RT, significant neurological damage may still occur.

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    Area of Science:

    • Neuro-oncology
    • Pediatric oncology
    • Radiation oncology

    Background:

    • Cranial radiation therapy (RT) and high-dose systemic methotrexate (MTX) are standard treatments for intracranial neoplasms.
    • Both treatments carry a risk of neurotoxicity.

    Observation:

    • A 5-year-old girl with pineocytoma received MTX followed by local RT.
    • She developed progressive brainstem dysfunction 4 months post-MTX therapy.

    Findings:

    • CT scans suggested radiation necrosis, confirmed at autopsy.
    • Combined MTX and cranial irradiation led to severe neurotoxicity, irrespective of treatment order.

    Implications:

    • This case highlights the potential for severe neurotoxicity when MTX and RT are used together.

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  • Careful consideration of treatment sequencing and monitoring for neurological complications is crucial in pediatric neuro-oncology.