[Chiasmatic radionecrosis after multifractionated radiotherapy of a temporal glioma]

A 45-year-old male received split course multiple daily fractionated radiotherapy for an anaplastic left parieto-temporal astrocytoma. A total dose of 60 grays was delivered by 15 fractions of 2 grays given in 5 days and repeated after a rest period of 15 days. Forty grays were delivered to the whole brain and 20 grays to the tumor area. No surgery or radiosensitizer or chemotherapy were used at any time. The patient noted progressive loss of vision in both eyes and became blind 9 months after irradiation. Post-mortem study revealed 2 areas of radionecrosis in the chiasma and corpus callosum, corresponding to the dose of 57-60 grays. The necrotic area were at a distance of the tumor remnants. The high Daily Dose Multifractionation schedule may be responsible for the radionecrosis.