Brain Tumor Res Treat.  2014 Oct;2(2):102-107. 10.14791/btrt.2014.2.2.102.

Procarbazine, CCNU, and Vincristine Chemotherapy in Gliomatosis Cerebri

• Lee HG
• Lee KS
• Lee WH
• Kim ST

• KMID: 2134280
• DOI: http://doi.org/10.14791/btrt.2014.2.2.102

Abstract

A 49-year-old female patient was admitted due to memory disturbances. Magnetic resonance (MR) imaging suggested gliomatosis cerebri (GC), which had spread to both insular lobes, both frontal and basal ganglia and the brain stem. A stereotactic biopsy was performed at the high signal intensity area of the T2-weighted MR image, and the revealed a diffuse astrocytoma. Radiation therapy was judged not to be an appropriate treatment for the patient because of her cognitive impairment. A combinatorial chemotherapy regiment consisting of Procarbazine, CCNU, and Vincristine (PCV) was agreed upon after discussion. The patient underwent six cycles of PCV chemotherapy (a full dose was applied until the 3rd cycle, and dose then was reduced to 75% for the remaining cycles). Although the patient exhibited side effects such as bone marrow suppression and gastrointestinal symptoms, these were managed by medication. Over the 28 months following initiation of treatment, the high signal area in the right frontal and temporal lobes in the T2-weighted MR image decreased, and the patient's cognitive function [global deterioration scale (GDS) 4 points, mini-mental state examination (MMSE) 25 point] also improved (GDS 1 points, MMSE 29 points). PCV chemotherapy can therefore be an alternative therapeutic option for patients with GC who cannot be treated with radiation therapy or other chemotherapies.

Keyword

Diffuse astrocytoma; Gliomatosis cerebri; Procarbazine; CCNU; Vincristine; Cognitive impairment

MeSH Terms

Astrocytoma
Basal Ganglia
Biopsy
Bone Marrow
Brain Stem
Drug Therapy*
Female
Humans
Lomustine*
Memory
Middle Aged
Neoplasms, Neuroepithelial*
Procarbazine*
Temporal Lobe
Vincristine*
Lomustine
Procarbazine
Vincristine

Figure

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  Fig. 1 Brain magnetic resonance imaging. A: T1-weighted magnetic resonance image: iso signal in both frontal lobes, both temporal lobes and the brain stem. B: T2 fluid attenuated inversion recovery: high signal in both frontal lobes, both temporal lobes, and brain stem. Brain sulcus is effaced in the tumor lesion. C: T1 enhancement image: no enhancement lesion is in tumor lesion.

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  Fig. 2 Magnetic resonance spectroscopy. In magnetic resonance spectroscopy, tumor lesion exhibits increased choline, levels, while N-acetyl-aspartate levels decreased.

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  Fig. 3 Positron emission tomography-computed tomography. In positron emission tomography-computed tomography images, the tumor lesion exhibits hypometabolism.

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  Fig. 4 Pathology. A: Hematoxylin and eosin staining exhibits increased amounts of chromatin and a dismorphic neucleus (×100). B: P53 immunostain: positive (>5%) (×250). C: Glial fibrillary acidic protein immunostain: it is well stained, so the tumor is glial cell origin (×100). D: Ki-67 gene immunostain: decreased gene expression (<5%) (×250).

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  Fig. 5 FLAIR image of pre- and post-chemotherapy. A: The T2-weighted magnetic resonance image at the time of diagnosis. B: The T2-weighted magnetic resonance image after chemotherapy: high signal decreases in right temporal lobe, the left or both frontal lobes (red arrows).

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