Elsevier

World Neurosurgery

Volume 108, December 2017, Pages 990.e11-990.e16
World Neurosurgery

Case Report
Regression of Recurrent High-Grade Glioma with Temozolomide, Dexamethasone, and Levetiracetam: Case Report and Review of the Literature

https://doi.org/10.1016/j.wneu.2017.08.136Get rights and content

Background

Treatment options for recurrent glioma of the brain include chemotherapy, radiotherapy, surgery, and palliation. Temozolomide appears to be effective in patients with recurrent high-grade gliomas.

Case Description

A middle-aged woman presented with a high-grade glioma of corpus callosum. The tumor, a grade 3 anaplastic oligodendroglioma, was excised, and chemoradiotherapy was administered. The patient presented with significant recurrence 5 years later. Repeat surgery and radiation were suggested but refused. She was given temozolomide and dexamethasone intermittently, and levetiracetam was continued. Magnetic resonance imaging performed at 10-month follow-up showed 90% remission.

Conclusions

There are a few reports in the literature of similar response to temozolomide and levetiracetam. Similar reports give more hope in the treatment of recurrent high grade glioma.

Introduction

Recurrent glioma of the brain is an incurable disease. Treatment options for recurrent glioma include chemotherapy, radiotherapy, surgery, and palliation. Temozolomide appears to be effective in patients with recurrent high-grade gliomas.1 In vitro and retrospective studies have shown dexamethasone and levetiracetam to inhibit tumor proliferation directly and to increase sensitivity to chemotherapy.2

Section snippets

Case Description

A 35-year-old woman presented with headache, vomiting, executive memory loss, and decreased sleep. Computed tomography of the brain showed an ill-defined heterogeneous mass 5 × 5 cm involving both frontal lobes and genu of corpus callosum. Multiple discrete, small calcifications were seen in the lesion. Significant perilesional edema was seen in bilateral frontal white matter (Figure 1). Magnetic resonance imaging (MRI) of the brain showed a bifrontal diffuse hyperintense lesion with a

Discussion and Review of Literature

High-grade glioma is an aggressive form of brain cancer. Treatment usually entails biopsy or resection if safe, followed by radiotherapy. Despite aggressive treatment, high-grade malignant gliomas (anaplastic astrocytoma and glioblastoma multiforme) have a poor prognosis.3 Most malignant gliomas (at least 70%) recur after initial treatment.1 Responses in recurrent disease are not enduring, and quality of life because of tumor growth is poor. Tumors with oligodendroglial components have improved

Conclusions

This is a report of a middle-aged woman with corpus callosal anaplastic glioma who had recurrence after surgery and chemoradiotherapy. She experienced near total remission after the recurrence with temozolomide, levetiracetam, and dexamethasone. A few similar cases of regression of high-grade glioma with these drugs have been reported in the literature. Similar reports give more hope in the treatment of recurrent high-grade glioma.

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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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