Fig. 2.

Progressive treatment necrosis (A–C; T1-weighted gadolinium-enhanced axial MRI sequences). (A) A 35-year-old male with right frontal low-grade astrocytoma (World Health Organization grade II) underwent surgical resection followed by TMZ-based chemo-RT treatment. Eight months post-RT completion he developed headaches of increased frequency and was found to have a new nodular focus of enhancement in the right frontal lobe subjacent to the resection cavity, with periventricular and corpus callosum involvement, a biopsy of which revealed TN. (B) Sequential TMZ was resumed and completed over the next 6 months; however, the patient experienced worsening of his symptoms as the region of enhancement continued to expand. (C) Despite initiation of corticosteroid and bevacizumab treatment, he developed progressive left-sided hemiparesis and cognitive decline over the following 2 years, prompting a second biopsy of the continually enhancing lesion, which again confirmed TN. Therapeutic management of symptomatic TN was continued; however, the patient deteriorated further, necessitating a transfer to hospice care, where he eventually passed away 2 years after the second biopsy.