ABSTRACT
AIMS AND BACKGROUND: Glioblastoma multiforme (GBM) is the most frequent primary central nervous system malignancy in adults, accounting for 50% of all primary intracranial malignancies. GBM mostly arises within the cerebral hemispheres and frequently affects patients in the fifth and sixth decades of life. Conversely, primary cerebellar GBM is a rather infrequent occurrence in the adult population, accounting for 1%-2.2% of all GBMs. Here we report a case of cerebellar GBM in an adult woman and provide an extensive review of the literature. METHODS: A 42-year-old woman was referred to our hospital for occipital constrictive headache, dizziness and gait disturbance. Multimodality imaging including computed tomography and magnetic resonance imaging (MRI) showed a right cerebellar mass. Gross total resection was performed. Histological examination showed grade IV GBM according to the World Health Organization classification, with a synchronous component of low-grade glioma. Immunohistochemistry showed positivity for p53 and negativity for epidermal growth factor receptor (EGFR). After surgical tumor excision, the patient underwent adjuvant radiation to the posterior fossa with an intensity-modulated approach for a total dose of 60 Gy in 30 fractions. In addition, she received concurrent and adjuvant chemotherapy with temozolomide. RESULTS: Treatment was well tolerated, with mild acute toxicity. There was no evidence of recurrence on brain and spinal gadolinium-enhanced MRI scans 4, 8 and 12 months after primary surgery. No late side effects were recorded. CONCLUSION: Our patient had several immunohistochemical characteristics of secondary glioblastoma such as p53 positivity, EGFR negativity and the presence of a low-grade glioma component. Intensity-modulated radiation therapy allowed us to safely deliver full-dose radiation with sparing of critical structures.
Subject(s)
Antineoplastic Agents, Alkylating/therapeutic use , Cerebellar Neoplasms/diagnosis , Cerebellar Neoplasms/therapy , Dacarbazine/analogs & derivatives , Glioblastoma/diagnosis , Glioblastoma/therapy , Radiotherapy, Intensity-Modulated , Adult , Biomarkers, Tumor/analysis , Cerebellar Neoplasms/chemistry , Cerebellar Neoplasms/complications , Chemoradiotherapy, Adjuvant , Dacarbazine/therapeutic use , Dizziness/etiology , ErbB Receptors/analysis , Female , Gait Disorders, Neurologic/etiology , Glioblastoma/chemistry , Glioblastoma/complications , Headache/etiology , Humans , Immunohistochemistry , Magnetic Resonance Spectroscopy , Neoplasm Grading , Radiotherapy Dosage , Temozolomide , Tomography, X-Ray Computed , Treatment Outcome , Tumor Suppressor Protein p53/analysisABSTRACT
Metastatic involvement of the penis is rare. About 80% of secondary lesions originate from pelvic primary tumors, mainly bladder and prostate. We present a case of prostatic mucinous adenocarcinoma with penile metastasis symptomatic for pain, which was treated with external-beam radiation (35 Gy/14 fractions; 2.5 Gy daily) combined with androgen deprivation, resulting in complete pain relief and objective response after treatment.
Subject(s)
Adenocarcinoma, Mucinous/diagnosis , Adenocarcinoma, Mucinous/secondary , Bone Neoplasms/diagnosis , Bone Neoplasms/secondary , Palliative Care/methods , Penile Neoplasms/diagnosis , Penile Neoplasms/secondary , Prostatic Neoplasms/pathology , Quality of Life , Adenocarcinoma, Mucinous/therapy , Anemia, Hemolytic/etiology , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bone Neoplasms/complications , Bone Neoplasms/therapy , Chemotherapy, Adjuvant , Disseminated Intravascular Coagulation/etiology , Dose Fractionation, Radiation , Fatal Outcome , Humans , Male , Middle Aged , Pain/etiology , Penile Neoplasms/therapy , Prostatic Neoplasms/therapy , Radiotherapy, AdjuvantABSTRACT
Radiochromic film has become an important tool to verify dose distributions in highly conformal radiation therapy such as IMRT. Recently, a new generation of these films, EBT3, has become available. EBT3 has the same composition and thickness of the sensitive layer of the previous EBT2 films, but its symmetric layer configuration allows the user to eliminate side orientation dependence, which is reported for EBT2 films. The most important EBT3 characteristics have been investigated, such as response at high-dose levels, sensitivity to scanner orientation and postirradiation coloration, energy and dose rate dependence, and orientation dependence with respect to film side. Additionally, different IMRT fields were measured with both EBT3 and EBT2 films and evaluated using gamma index analysis. The results obtained show that most of the characteristics of EBT3 film are similar to the EBT2 film, but the orientation dependence with respect to film side is completely eliminated in EBT3 films. The study confirms that EBT3 film can be used for clinical practice in the same way as the previous EBT2 film.
