ABSTRACT
Cranial radiotherapy (RT) is an irradiated way to treat patients with brain malignancies. Seizure is the most common symptom. Due to the frequency of seizure risk, cranial RT is usually received concomitant with previously initiated antiepileptic drugs (AED). This combination can lead to erythema multiforme (EM) like serious skin reactions starting from the irradiated port site and spreading to whole cutaneous surfaces and mucosal membranes. This clinical entity is named after as an acronym of components which are Erythema Multiforme associated with Phenytoin And Cranial RadiationTherapy as EMPACT syndrome. Most cases of EMPACT syndrome are reported with phenytoin in the literature, but there are no reported cases with levetiracetam to the best of our knowledge in the literature. Here, we report a 62-year-old male with glioblastoma, presented with severe conjunctivitis, extensive bleeding erosions in his oral mucosa and erythematous macular eruptions on the right temporoparietal port region of the scalp, and EM-like generalized lesions involved neck, chest, back, and arms following the end of his cranial RT. He was diagnosed with EMPACT syndrome, related to using levetiracetam concomitant with cranial RT. Early diagnosis is crucial for the complete response of treatment. Physicians should be alert to possible skin and mucosal reactions of patients under levetiracetam treatment, especially co-existing use of cranial RT.
ABSTRACT
BACKGROUND: The purpose of this study is to identify the differences with respect to survival and prognostic factors in a comparison between radiotherapy-receiving glioblastoma (GBM) patients above and below 65 years of age. METHODS: The results of 157 patients with GBM were analyzed retrospectively. Patients were divided into two groups as those below and above 65 years of age. A comparison was drawn with respect to each group's demographic characteristics, treatment methods, and findings. RESULTS: Out of a total of 157 patients, 53 patients (33.8%) were above 65 years of age. Karnofsky performance status (KPS) was weaker among older patients (P = 0.002). On the other hand, with respect to radiotherapy dose, among older patient group, greater hypofractionation and whole-brain radiotherapy was applied (P = 0.003) compared with younger patients. The survival rates for 1, 2, and 5 years among patients aged <65 years were 63%, 30%, and 3%, respectively, and in patients aged ≥65 years were 43%, 13%, and 0%, respectively. In univariate analyses, a comparison between patients below and above 65 years of age revealed that values higher than 80 KPS (P = 0.002), applying total excision (P < 0.001), receiving concurrent chemotherapy (P = 0.004), receiving conventional radiotherapy (P < 0.001), and adjuvant chemotherapy (P < 0.001) were effective factors on overall survival rates. CONCLUSION: In the patient group above 65 years of age, the patient should be attentively selected before opting for a specific treatment, age alone should not be the sole determinant factor. Rather, by considering the KPS scores, potential aggressive treatment options should also be applied.
