Clinical problem

This is a 28-year-old right-handed woman with a long-standing history of headaches of increasing severity. An MR scan was performed showing a non-enhancing lesion in the left parietal lobe. The patient underwent an excisional biopsy of the lesion in August 2003. At the time of surgery, there was difficulty distinguishing between normal and tumor tissue, and with the patient's desire to not risk a neurologic deficit, an aggressive resection was not attempted. Pathology showed a grade II astrocytoma.

Treatment options

Adjuvant radiotherapy of low-grade gliomas remains controversial. There is little evidence to suggest a benefit for radiotherapy after complete resection of tumors. However, in the setting of an incomplete resection, several retrospective series have reported improvement in survival after adjuvant radiation. Recently, a prospective randomized study has been completed addressing this issue and early results have been reported (1). Though there is no difference in overall survival at 5 years between patients who did and did not receive radiotherapy, failure free survival was significantly improved in the treated group. Additionally, the authors expressed concern that quality of life in the untreated group might be inferior due to complications of recurrent tumor. Long-term results from this study will be required to definitively answer this question, but this study together with data from several retrospective studies supports the use of radiotherapy when a complete resection cannot be performed.

Figure 1. Stereotactic intensity modulated radiotherapy delivers highly conformal radiation to the target, minimizing side effects of treatment.

Comments

The patient was treated with 5040 cGy in 28 fractions using the Novalis stereotactic intensity modulated radiotherapy unit. With the ability to precisely localize and conform the radiation beams, side effects of fatigue and hair loss were minimal. Follow-up imaging is pending, but at the completion of treatment the patient had near-complete resolution of her headaches.

References

Karim AB, Afra D, Cornu P, Bleehan N, Schraub S, De Witte O, Darcel F, Stenning S, Pierart M, Van Glabbeke M. Randomized trial on the efficacy of radiotherapy for cerebral low-grade glioma in the adult: European Organization for Research and Treatment of Cancer Study 22845 with the Medical Research Council study BRO4: an interim analysis. Int J Radiat Oncol Biol Phys 52(2):316-24, 20

How to refer

Because of the specific nature and complexity of the services we provide, patients must have a consultation with one of our physicians prior to being referred to the center.
To schedule an appointment with one of our physicians, please contact Precision Radiotherapy at 513-475-7777.