Glioblastoma and radiation necrosis

Hi. Looking for thoughts on this incoming referral for STRN from neurologist. Hx: Presented with memory issues and confusion, lesion on MRI, surgery Dec 2022, pathology (+) glioblastoma, EBRT plus temozolomide, finished on 02/27/2023 (to 58Gy in 29Fx). Neuro status declined at end of treatment, required steroids. Declined further chemo

Now presents to neuro with decline in symptoms: short term memory poor (unchanged), more confused, unsteady gait, lacks peripheral vision, headaches, numb left upper and lower extremities. 9/12/24 MRI: increase of enhancement and related FLAIR changes, less prominent than prior to bevacizumab (2 cycles). Per neuro "MRI shows increase that could be related to radiation effect (necrosis) or tumor progression". Rec to restart bevacizumab due to MRI results and symptoms. Patient declining and requesting HBOT. Doc favors bevacizumab based on available literature. No anti cancer treatment since Jan 2024.

How can we know symptoms post radiation are due to necrosis and not tumor progression (as also stated by neuro post MRI)? Also, the patient is declining rec from his neurologist. Thoughts on diving for STRN? Thank you!

Sep 17, 2024 by Sarah Karson, RN, BSN

1 replies

Mike White
MD, UHM, MMM, CWS

Sarah,

This Is unfortunately not a clear cut case. I would try to pin down the radiologist to see if the MR findings represent STRN of the brain. Barring that, a frank discussion by your physician and the hematologist should be had to discuss the role of HBOT.

Sep 18, 2024

* Information provided without clinical evaluation and is not intended as a replacement for in-person consultation with a medical professional. The information provided through Curbside Consult is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.

Basic Navigation

Feature Navigation

Solutions

Individuals:

Institutions:

Special Features:

Newsletter Signup