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Clinical improvement of diffuse intrinsic pontine glioma treated with radiation therapy concurrent with temozolomide: A case report.
- Source :
-
The Medical journal of Malaysia [Med J Malaysia] 2024 Aug; Vol. 79 (Suppl 4), pp. 87-90. - Publication Year :
- 2024
-
Abstract
- Diffuse intrinsic pontine glioma (DIPG) is a highly aggressive paediatric brain tumour and nowadays has not had satisfactory result, with most patients do not survive within 1 year of diagnosis. Due to its proximity to critical organs, surgery is avoided, and radiation is the mainstay of treatment. In this case report, we present a case of DIPG treated with radiation and concurrent temozolomide. A 7- year-old child was admitted with complaints of weakness in the eyelid, upper and lower limbs 2 months ago. Physical examination showed tetra paresis and bilateral cranial nerve palsy. Magnetic resonance imaging (MRI) scan showed intracranial tumour consistent with DIPG. Diagnosis was made based on imaging as surgery or biopsy can lead to further morbidity. The patient underwent radiotherapy with concurrent chemotherapy of temozolomide. Radiation was given by dose of 54 Gy/30 fractions (30 × 1.8 Gy) with volumetric arc therapy (VMAT). Due to technical issue after the first five irradiations resulting in 2 weeks delay, boosting of dose by 5 × 1.8 Gy was then given, hence, the total dose was 63 Gy. The booster only targeted the gross tumour volume. Following radiation, the patient felt clinical improvement. Eyelid and limb movement improved since the 15th fraction. At the last fraction, the patient's condition improved symptomatically, but experienced complaints related to post radiation oedema including dizziness and nausea. These complaints were improved upon steroids administration. The MRI evaluation will be done after 8 to 12 weeks of radiation, considering the effects of acute radiation could still occur at this period. In conclusion, a combination of radiotherapy and temozolomide could be an option for DIPG management, with tolerable acute toxicity and possible clinical improvements.
- Subjects :
- Humans
Child
Diffuse Intrinsic Pontine Glioma therapy
Diffuse Intrinsic Pontine Glioma drug therapy
Diffuse Intrinsic Pontine Glioma radiotherapy
Male
Antineoplastic Agents, Alkylating therapeutic use
Antineoplastic Agents, Alkylating administration & dosage
Dacarbazine analogs & derivatives
Dacarbazine therapeutic use
Magnetic Resonance Imaging
Chemoradiotherapy
Temozolomide therapeutic use
Temozolomide administration & dosage
Brain Stem Neoplasms radiotherapy
Brain Stem Neoplasms therapy
Brain Stem Neoplasms drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 0300-5283
- Volume :
- 79
- Issue :
- Suppl 4
- Database :
- MEDLINE
- Journal :
- The Medical journal of Malaysia
- Publication Type :
- Academic Journal
- Accession number :
- 39215422