Radiation necrosis of a high-grade glioma.

Deepak Raghavan, MD, Jerrold Boxerman, MD, PhD, Suriya Jeyapalan, MD, MPH, and Jeffrey Rogg, MD  a 64 year old Male was referred To The neurosurgiCal serviCe at Rhode Island Hospital for evaluation of a left frontal mass. Given proximity of the lesion to eloquent cortex, resection was not performed and a histopathologic diagnosis of grade III anaplastic oligoastrocytoma was made through biopsy. The patient was enrolled in an experimental treatment protocol that included Paclitaxel Poliglumex (PPX; a microtubule stabilizer and mitotic inhibitor with a radiosensitization index of 4-8), temozolomide, and radiation. The patient also underwent two cycles of maintenance temozolomide therapy and a third cycle of dose-intensive temozolomide therapy. Serial MR imaging with perfusion-weighted imaging was performed at multiple time points throughout treatment.