ABSTRACT
Epstein-Barr virus-associated smooth muscle tumour (EBV-SMT) is a unique condition which affects immunocompromised patients. We describe the favourable outcome of a patient with acquired immune deficiency syndrome (AIDS)-related multi-centric EBV-SMT involving the posterior fossa and spine treated with surgery and adjuvant volumetric modulated arc therapy comprising 50 Gy in 25 fractions to four sites initially to the brain and lumbar spine followed by sixth to ninth thoracic vertebrae (T6-T9) and sacrum a year later. Reported literature suggests that AIDS-related EBV-SMTs are more sensitive to radiotherapy. However, compliance to the highly active anti-retroviral therapy is paramount in preventing future recurrence. This case also emphasises the importance of multidisciplinary management in ensuring the best possible outcome.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Brain/diagnostic imaging , Central Nervous System Neoplasms/pathology , Central Nervous System Neoplasms/radiotherapy , Central Nervous System Neoplasms/surgery , Epstein-Barr Virus Infections/complications , Herpesvirus 4, Human/isolation & purification , Radiotherapy, Adjuvant , Smooth Muscle Tumor/pathology , Smooth Muscle Tumor/surgery , Smooth Muscle Tumor/virology , Acquired Immunodeficiency Syndrome/drug therapy , Adult , Antiretroviral Therapy, Highly Active , Brain/pathology , Central Nervous System Neoplasms/virology , Epstein-Barr Virus Infections/diagnosis , Epstein-Barr Virus Infections/virology , Humans , Immunocompromised Host , Magnetic Resonance Imaging , Male , Radiotherapy, Adjuvant/adverse effects , Smooth Muscle Tumor/radiotherapy , Treatment Outcome , Viral LoadABSTRACT
BACKGROUND: Nadir GH during oral glucose tolerance test (OGTT) is the gold-standard test of GH secretion in treated acromegaly. However, it was recently reported that variability in GH is reduced postradiotherapy, making basal GH a potential surrogate marker for nadir GH in such patients. OBJECTIVE: We aimed to investigate how predictive basal GH is of nadir GH and IGF-I, and whether radiotherapy influenced these relationships. DESIGN: A total of 226 pairs of basal and nadir GH values from 76 treated acromegalic patients were analysed. Basal GH was defined as the fasting serum GH immediately prior to OGTT. RESULTS: A highly positive linear correlation (Pearson correlation = 0.955, P < 0.01) between basal and nadir GH was found. Negative predictive value for basal GH < 1 microg/l with respect to nadir GH > 1 microg/l was 100% (53/53 in radiotherapy group, 15/15 in nonradiotherapy group). Positive predictive values for basal GH > 2 microg/l with respect to nadir GH > 1 microg/l for patients treated and not treated with radiotherapy were 96.7% (88/91) and 95.2% (20/21), respectively. No significant difference between concordance of basal and nadir GH with IGF-I in assessment of disease activity was found. Discordance between IGF-I and nadir or basal GH < 1 microg/l was lower in the radiotherapy group than nonradiotherapy group, but this was nonsignificant. CONCLUSIONS: Basal GH < 1 microg/l and > 2 microg/l are highly predictive of nadir GH < 1 microg/l and > 1 microg/l, respectively, regardless of previous radiotherapy. Basal GH is as good as nadir GH in concordance with IGF-I. We therefore suggest basal GH is a useful test of disease activity in treated acromegaly, and can reliably replace OGTT unless basal GH is between 1 microg/l and 2 microg/l.
