Management of tumor bed cysts after chemotherapeutic wafer implantation

Report of four cases

View More View Less
  • 1 Duke University School of Medicine, and Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

✓ Adjuvant use of 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) wafers with surgical resection is becoming common for the treatment of malignant gliomas. Cyst formation in the tumor resection cavity is a recently described complication associated with the use of BCNU wafers. There is currently no report in which successful management of this complication without additional surgical intervention is described.

The authors describe four patients in whom postoperative cysts developed in the tumor resection cavity after placement of BCNU wafers. These include a 38-year-old man with a left frontoparietal tumor, a 48-year-old man with a right frontal lobe tumor, a 78-year-old man with a left parietooccipital tumor, and a 61-year-old woman with a left frontotemporal tumor. Histopathological studies of biopsy samples revealed malignant glioma in each patient. All four patients had unremarkable perioperative courses, were discharged within 3 to 8 days of surgery, and subsequently returned with acute neurological deterioration. Follow-up magnetic resonance (MR) imaging demonstrated cyst formation with significant mass effect at the previous resection site. Three patients were treated with high-dose dexamethasone and returned to their neurological baseline over an 8-day period. The fourth patient improved after surgical drainage and biopsy sampling of the cyst, which revealed no evidence of infection or recurrent tumor, but again sought medical care 2 weeks later with cyst recurrence necessitating high-dose steroid therapy. On MR images at least a 30% reduction in cyst size was demonstrated in all four patients, each of whom remained clinically stable at 2, 6, 6, and 4 months of follow-up review.

Neurosurgeons should be aware of the potential for postoperative cyst formation accompanied by clinically significant mass effect after BCNU wafer implantation, as well as the potential for successful nonsurgical management leading to clinical and radiological improvement.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1.

    Afra D, , Norman D, & Levin VA: Cysts in malignant gliomas. Identification by computerized tomography. J Neurosurg 53:821825, 1980 Afra D, Norman D, Levin VA: Cysts in malignant gliomas. Identification by computerized tomography. J Neurosurg 53:821–825, 1980

    • Search Google Scholar
    • Export Citation
  • 2.

    Bodsch W, , Rommel T, & Ophoff BG, et al: Factors responsible for the retention of fluid in human tumor edema and the effect of dexamethasone. J Neurosurg 67:250257, 1987 Bodsch W, Rommel T, Ophoff BG, et al: Factors responsible for the retention of fluid in human tumor edema and the effect of dexamethasone. J Neurosurg 67:250–257, 1987

    • Search Google Scholar
    • Export Citation
  • 3.

    Brem H, , Ewend MG, & Piantadosi S, et al: The safety of interstitial chemotherapy with BCNU-loaded polymer followed by radiation therapy in the treatment of newly diagnosed malignant gliomas: phase I trial. J Neurooncol 26:111123, 1995 Brem H, Ewend MG, Piantadosi S, et al: The safety of interstitial chemotherapy with BCNU-loaded polymer followed by radiation therapy in the treatment of newly diagnosed malignant gliomas: phase I trial. J Neurooncol 26:111–123, 1995

    • Search Google Scholar
    • Export Citation
  • 4.

    Brem H, , Mahaley MS Jr, & Vick NA, et al: Interstitial chemotherapy with drug polymer implants for the treatment of recurrent gliomas. J Neurosurg 74:441446, 1991 Brem H, Mahaley MS Jr, Vick NA, et al: Interstitial chemotherapy with drug polymer implants for the treatment of recurrent gliomas. J Neurosurg 74:441–446, 1991

    • Search Google Scholar
    • Export Citation
  • 5.

    Brem H, , Piantadosi S, & Burger PC, et al: Placebo-controlled trial of safety and efficacy of intraoperative controlled delivery by biodegradable polymers of chemotherapy for recurrent gliomas. The Polymer-brain Tumor Treatment Group. Lancet 345:10081012, 1995 Brem H, Piantadosi S, Burger PC, et al: Placebo-controlled trial of safety and efficacy of intraoperative controlled delivery by biodegradable polymers of chemotherapy for recurrent gliomas. The Polymer-brain Tumor Treatment Group. Lancet 345:1008–1012, 1995

    • Search Google Scholar
    • Export Citation
  • 6.

    Cairncross JG, , Macdonald DR, & Pexman JH, et al: Steroid-induced CT changes in patients with recurrent malignant glioma. Neurology 38:724726, 1988 Cairncross JG, Macdonald DR, Pexman JH, et al: Steroid-induced CT changes in patients with recurrent malignant glioma. Neurology 38:724–726, 1988

    • Search Google Scholar
    • Export Citation
  • 7.

    Chang AE, & Shu S: Immunotherapy with sensitized lymphocytes. Cancer Invest 10:357369, 1992 Chang AE, Shu S: Immunotherapy with sensitized lymphocytes. Cancer Invest 10:357–369, 1992

    • Search Google Scholar
    • Export Citation
  • 8.

    Engelhard HH: Tumor bed cyst formation after BCNU wafer implantation: report of two cases. Surg Neurol 53:220224, 2000 Engelhard HH: Tumor bed cyst formation after BCNU wafer implantation: report of two cases. Surg Neurol 53:220–224, 2000

    • Search Google Scholar
    • Export Citation
  • 9.

    Hedley-Whyte ET, & Hsu DW: Effect of dexamethasone on blood-brain barrier in the normal mouse. Ann Neurol 19:373377, 1986 Hedley-Whyte ET, Hsu DW: Effect of dexamethasone on blood-brain barrier in the normal mouse. Ann Neurol 19:373–377, 1986

    • Search Google Scholar
    • Export Citation
  • 10.

    Jellinger K: Glioblastoma multiforme: morphology and biology. Acta Neurochir 42:532, 1978 Jellinger K: Glioblastoma multiforme: morphology and biology. Acta Neurochir 42:5–32, 1978

    • Search Google Scholar
    • Export Citation
  • 11.

    Kleihues P, & Sobin LH: World Health Organization classification of tumors. Cancer 88:2887, 2000 Kleihues P, Sobin LH: World Health Organization classification of tumors. Cancer 88:2887, 2000

    • Search Google Scholar
    • Export Citation
  • 12.

    Kramer S, & Lee KF: Complications of radiation therapy: the central nervous system. Semin Roentgenol 9: 7583, 1974 Kramer S, Lee KF: Complications of radiation therapy: the central nervous system. Semin Roentgenol 9:75–83, 1974

    • Search Google Scholar
    • Export Citation
  • 13.

    Loftus CM, , Copeland BR, & Carmel PW: Cystic supratentorial gliomas: natural history and evaluation of modes of surgical therapy. Neurosurgery 17:1924, 1985 Loftus CM, Copeland BR, Carmel PW: Cystic supratentorial gliomas: natural history and evaluation of modes of surgical therapy. Neurosurgery 17:19–24, 1985

    • Search Google Scholar
    • Export Citation
  • 14.

    Lohle PN, , Verhagen IT, & Teelken AW, et al: The pathogenesis of cerebral gliomatous cysts. Neurosurgery 30:180185, 1992 Lohle PN, Verhagen IT, Teelken AW, et al: The pathogenesis of cerebral gliomatous cysts. Neurosurgery 30:180–185, 1992

    • Search Google Scholar
    • Export Citation
  • 15.

    Poisson M, , Philippon J, & van Effenterre R, et al: Cerebral pseudocysts following chemotherapy of glioblastomas. Acta Neurochir 39:143149, 1977 Poisson M, Philippon J, van Effenterre R, et al: Cerebral pseudocysts following chemotherapy of glioblastomas. Acta Neurochir 39:143–149, 1977

    • Search Google Scholar
    • Export Citation
  • 16.

    Schiffer D, , Giordana MT, & Paoletti P, et al: Pathology of human malignant gliomas after radiation and chemotherapy. Acta Neurochir 53:205216, 1980 Schiffer D, Giordana MT, Paoletti P, et al: Pathology of human malignant gliomas after radiation and chemotherapy. Acta Neurochir 53:205–216, 1980

    • Search Google Scholar
    • Export Citation
  • 17.

    Smith MM, , Thompson JE, & Castillo M, et al: MR of recurrent high-grade astrocytomas after intralesional immunotherapy. AJNR 17:10651071, 1996 Smith MM, Thompson JE, Castillo M, et al: MR of recurrent high-grade astrocytomas after intralesional immunotherapy. AJNR 17:1065–1071, 1996

    • Search Google Scholar
    • Export Citation
  • 18.

    Subach BR, , Witham TF, & Kondziolka D, et al: Morbidity and survival after 1,3-bis(2-chloroethyl)-1-nitrosourea wafer implantation for recurrent glioblastoma: a retrospective case—matched cohort series. Neurosurgery 45:1723, 1999 Subach BR, Witham TF, Kondziolka D, et al: Morbidity and survival after 1,3-bis(2-chloroethyl)-1-nitrosourea wafer implantation for recurrent glioblastoma: a retrospective case—matched cohort series. Neurosurgery 45:17–23, 1999

    • Search Google Scholar
    • Export Citation
  • 19.

    Valtonen S, , Timonen U, & Toivanen P, et al: Interstitial chemotherapy with carmustine-loaded polymers for high-grade gliomas: a randomized double-blind study. Neurosurgery 41:4449, 1997 Valtonen S, Timonen U, Toivanen P, et al: Interstitial chemotherapy with carmustine-loaded polymers for high-grade gliomas: a randomized double-blind study. Neurosurgery 41:44–49, 1997

    • Search Google Scholar
    • Export Citation
  • 20.

    Volc D, , Jellinger K, & Flament H, et al: Cerebral space-occupying cysts following radiation and chemotherapy of malignant gliomas. Acta Neurochir 57:177193, 1981 Volc D, Jellinger K, Flament H, et al: Cerebral space-occupying cysts following radiation and chemotherapy of malignant gliomas. Acta Neurochir 57:177–193, 1981

    • Search Google Scholar
    • Export Citation
  • 21.

    Willson N, & Duffy PE: Morphologic changes associated with combined BCNU and radiation therapy in glioblastoma multiforme. Neurology 24:465471, 1974 Willson N, Duffy PE: Morphologic changes associated with combined BCNU and radiation therapy in glioblastoma multiforme. Neurology 24:465–471, 1974

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 537 67 6
Full Text Views 157 7 1
PDF Downloads 109 7 1
EPUB Downloads 0 0 0