Radiation-Induced Glioblastoma Multiforme in a Remitted Acute Lymphocytic Leukemia Patient

A 17-year-old female patient admitted with complaints of speech disturbance and right side weakness. She had been previously diagnosed as ALL 10 years before, and was given chemotherapy according to Children's Cancer Group (CCG) 1881 trial protocol administrating prednisolone, vincristine, methotrexate, asparaginase and mercaptopurine. This brought up complete remission proven from serial bone marrow aspiration examinations. Forty-four months after the primary chemotherapy, CNS relapse was suspected from periodically planned cerebrospinal fluid cytospin studies. Further chemotherapy following CCG 1967 trial protocol, intrathecal triple therapy administrating methotrexate, cytarabine and hydrocortisone and WBRT of 19.5 Gy was applied. Her general condition was maintained fairly well thereafter, until the development of headache, vomiting and left side weakness at one month after the beginning of chemotherapy. Brain magnetic resonance imaging (MRI) revealed intracerebral hemorrhage at right parieto-occipiral lobe and thalamus (Fig. The patient recovered with conservative treatment. She had only mild hemiparesis of left extremities and was maintained at remitted status of ALL thereafter.