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Chemoradiation for GBM: common issues
•
continuous temozolomide associated with
lymphopenia
–
exacerbated by prior and concomitant steroid treatment
–
prophylactic co-trimoxazole or pentamidine recommended if lymphocyte count <0.5
•
occasional patients experience pancytopenia during concomitant treatment
•
adjuvant temozolomide associated with
neutropenia, thrombocytopenia and
fatigue
•
no increase in
late neurotoxicity
documented to date
•
‘pseudoprogression’
on post-RT imaging
–
may reflect treatment related inflammation or necrosis
–
no validated imaging methods for discriminating progression from
pseudoprogression