ArticleCureus2026
Tumor Recurrence or Radionecrosis: A Clinical Dilemma in Long-Term Survivors of Low-Grade Diffuse Glioma With Drug-Resistant Epilepsy.
Article in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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9 authors.
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Abstract
Low-grade diffuse gliomas with isocitrate dehydrogenase (IDH) mutations predominantly affect young adults and are frequently associated with prolonged survival, requiring extended neuro-oncological follow-up. In these patients, differentiating tumor recurrence from radionecrosis after radiotherapy remains a major diagnostic challenge because both entities may present with overlapping clinical manifestations and conventional imaging findings. We present the case of a 35-year-old man with an IDH-mutant grade 2 astrocytoma located in the left temporo-parieto-insular region who underwent subtotal surgical resection followed by radiotherapy and adjuvant temozolomide. During follow-up, he developed focal drug-resistant structural epilepsy with progressive seizure burden despite multiple antiseizure medications. Serial MRI demonstrated the appearance and interval growth of a nodular enhancing lesion within the frontal operculum adjacent to the surgical cavity, raising concern for tumor recurrence. Given the diagnostic uncertainty, 18F-fluoroethyl-L-tyrosine positron emission tomography (18F-FET PET) was performed, demonstrating mild and homogeneous amino acid uptake with a tumor-to-background ratio (TBR) of 1.7 and maximum standardized uptake value (SUVmax) of 2.1, findings favoring treatment-related changes and radionecrosis rather than active tumor progression. Considering the imaging characteristics, eloquent cortical location, and multidisciplinary assessment, a conservative neuro-oncological management approach was favored. This case highlights the importance of integrating advanced metabolic imaging techniques such as 18F-FET PET into the evaluation of long-term survivors of low-grade gliomas (LGGs) presenting with worsening epilepsy and new enhancing lesions after radiotherapy. Amino acid PET imaging may represent a valuable complementary tool for distinguishing radionecrosis from recurrent tumor activity in complex neuro-oncological cases.
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