open access

Vol 21, No 1 (2016)
Published online: 2016-01-01
Submitted: 2015-04-25
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Metachronous medulloblastoma and glioblastoma: Implications for clinical and technical aspects of re-irradiation

Vivek Verma, Rajesh R. Kulkarni, Abhijeet R. Bhirud, Nathan R. Bennion, Rodney D. McComb, Chi Lin
DOI: 10.1016/j.rpor.2015.10.002
·
Rep Pract Oncol Radiother 2016;21(1):84-89.

open access

Vol 21, No 1 (2016)
Published online: 2016-01-01
Submitted: 2015-04-25

Abstract

A seven-year-old male underwent surgical resection and chemoradiation for average risk medulloblastoma; twelve years later, the presence of a necrotic and infiltrative mass in the same area and invading the brainstem prompted a subtotal resection. Pathology was indicative of glioblastoma. He was then treated with concurrent temozolomide and using biologically effective dose calculations for gross residual tumor tissue in the brainstem as well as brainstem tolerance, a radiotherapy dose of 3750[[ce:hsp sp="0.25"/]]cGy was chosen, fractionated in twice-daily fractions of 125[[ce:hsp sp="0.25"/]]cGy each. The gross tumor volume was expanded with a 5[[ce:hsp sp="0.25"/]]mm margin to the planning target volume, which was also judiciously subtracted from the normal brainstem. He completed his radiotherapy course with subsequent imaging free of residual tumor and continued adjuvant temozolomide and remains under follow-up surveillance. This case underscores the rarity of metachronous medulloblastoma and glioblastoma, of which only five known cases heretofore have been described. We discuss the technicalities of radiotherapy planning in this patient, including common hurdles for radiation oncologists in similar patients.

Abstract

A seven-year-old male underwent surgical resection and chemoradiation for average risk medulloblastoma; twelve years later, the presence of a necrotic and infiltrative mass in the same area and invading the brainstem prompted a subtotal resection. Pathology was indicative of glioblastoma. He was then treated with concurrent temozolomide and using biologically effective dose calculations for gross residual tumor tissue in the brainstem as well as brainstem tolerance, a radiotherapy dose of 3750[[ce:hsp sp="0.25"/]]cGy was chosen, fractionated in twice-daily fractions of 125[[ce:hsp sp="0.25"/]]cGy each. The gross tumor volume was expanded with a 5[[ce:hsp sp="0.25"/]]mm margin to the planning target volume, which was also judiciously subtracted from the normal brainstem. He completed his radiotherapy course with subsequent imaging free of residual tumor and continued adjuvant temozolomide and remains under follow-up surveillance. This case underscores the rarity of metachronous medulloblastoma and glioblastoma, of which only five known cases heretofore have been described. We discuss the technicalities of radiotherapy planning in this patient, including common hurdles for radiation oncologists in similar patients.

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Keywords

Medulloblastoma; Glioblastoma; Re-irradiation; Brainstem tolerance; Toxicity

About this article
Title

Metachronous medulloblastoma and glioblastoma: Implications for clinical and technical aspects of re-irradiation

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 21, No 1 (2016)

Pages

84-89

Published online

2016-01-01

DOI

10.1016/j.rpor.2015.10.002

Bibliographic record

Rep Pract Oncol Radiother 2016;21(1):84-89.

Keywords

Medulloblastoma
Glioblastoma
Re-irradiation
Brainstem tolerance
Toxicity

Authors

Vivek Verma
Rajesh R. Kulkarni
Abhijeet R. Bhirud
Nathan R. Bennion
Rodney D. McComb
Chi Lin

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