S194 reports of practical oncology and radiotherapy 1 8 ( 2 0 1 3 ) S186–S197
Method. A 9-year-old female patient presented in June 2009 with vomiting and headache. Cranial CT and MRI:
hypothalamic–chiasmatic tumor extending into the left cerebral peduncle and hippocampus with cerebellar folia distortion,
affecting both hemispheres and vermis suggestive of low-grade glial tumor. Began chemotherapy treatment in December 2009.
MRI (February 2010): increased lesion. Patient is referred in April 2010 for RT.
Results. The patient received a dose of 50.4 Gy at 1.8/day in tumor region by four isocentric fields with energies of 6 and 15 mV. Sub-
sequently boosted from previous volume to 54 Gy. MRI (June 2010): practical resolution of the tumor. October 2010: disconnection
from environment with staring, rigidity, loss of urinary sphincter control. CT brain: hydrocephalus. Ventriculoperitoneal shunt
was placed. MRI (February 2011): diffuse pachyleptomeningitis suggesting leptomeningeal carcinomatosis Vs infection. With
suspicion of TB, tuberculostatic treatment was administered. March 2011: brain biopsy was performed: WHO grade III anaplastic
oligodendroglioma. Temozolomide treatment was initiated with progression in December 2011. She died on May 2012.
Conclusions. The doses in brain tumors have been of 45–60 Gy with fractionation of 1.8 Gy, but a phase III prospective, randomized
EORTC study showed that low-grade OPG show no relationship between radiation dose and tumor response because it is normal
to stay in the lower limit of said range (45–50 Gy). The use of RTEF and IMRT achieve a good rate of compliance and help reduce
radiation volumes, achieving the same results with less toxicity, obtaining similar clinical outcomes except for comprehensive
doses whose possible deleterious effects are yet to be specified.
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Papillary tumor of the pineal region. Case report
C. Gil, A. Nieto, O. Alonso, C. Cigarral, L. Pérez-Romasanta
Hospital Universitario de Salamanca, H. Clínico, Oncología Radioterápica, Spain
Introduction. Papillary tumors of the pineal region (PTPR) were recognized as a distinct entity in the 2007 (WHO). Clinical presenta-
tion includes headache and obstructive hydrocephalus and it is frequent local recurrences. The treatment remains controversial.
Objective. A case of PTPR and its multidisciplinary treatment.
Case report. We describe a case of PTPR in a 54 year-old male who presented giddiness and headache of 2 years duration. Mag-
netic resonance imaging (MRI) showed an extraaxial and heterogeneous pineal gland lesion measuring 2 cm × 0.9 cm × 0.5 cm
with associated obstructive hydrocephalus. An endoscopic third ventriculostomy was performed followed by subtotal resection.
Histologically, the tumor was composed of polygonal cells, arranged in solid sheets with multilayered papillary architecture.
The predominant population of tumor cells showed esoinophilic cytoplasm. The tumor cells were immunoreactive for vimentin,
CAM5.2, CK18 and AE1/AE3, but negative for (GFAP). Ki67:4%. Two months later, the patient went to the emergency service with
an alteration to the march, drowsiness and vomiting. The CT scan showed a clear increase in the ventricular size reason why
is performed a ventricular–peritoneal derivation, with an adequate control of symptoms and of the obstructive hydrocephalus.
The post-surgery MRI revealed a 1.3 cm × 0.7 cm residual tumor. The neuro-oncology group decided to give local radiation of
54 Gy/2 Gy.
Results. The MRI revealed no changed in residual tumor and complete resolution of the hydrocephalus. The patient has a left
temporal hemianopsy and is in follow-up.
Discussion PTPR is considered as a separate entity from plexus papilloma, differentiated by the expression of cytokeratins, the
CK18 associated with PTPR and with the ependymoma has a strong immunoreactivity to GFAP difference with PTRP who is
absent. The total resection was the factor strongly associated with overall survival and recurrence. The requirement of radiation
after total resection with no aggressive histology is an alternative treatment approach that may result in high local control.
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Patterns of failure in patients with glioblastoma treated with surgery-IMRT-temozolamide
M. Rodriguez-ruiz 1 , A. Olarte 1 , E. Arevalo 2 , M. Moreno 1 , L. Arbea 1 , P. Dominguez 3 , J. Aramendia 2 , M. Idoate 4 ,
S. Tejada 5 , J. Arbizu 6 , R. Martinez-monge 1 , J. Aristu 1
1 Clinica Universitaria de Navarra, Radiation Oncology, Spain
2 Clinica Universitaria de Navarra, Medical Oncology, Spain
3 Clinica Universitaria de Navarra, Radiology, Spain
4 Clinica Universitaria de Navarra, Anatomical Pathology, Spain
5 Clinica Universitaria de Navarra, Neurosurgery, Spain
6 Clinica Universitaria de Navarra, Nuclear Medical, Spain
Introduction. The patterns of failure in patients (pats) with glioblastoma (GB) treated with conventional treatment are predomi-
nantly local (80–90%). Few studies have evaluated the patterns of recurrence using IMRT in patients with GB.
Material and methods. Pats with pathological diagnosis of GB were included in a prospective study. Treatment consisted of maximal
surgical resection using 5-ALA-guided surgery, postop-IMRT with concomitant-temozolamide (TMZ) and adjuvant-TMZ. Target
volumes were outlined using trimodal image fusion with (CT/11C-MET-PET/MR). GTV was defined as the surgical cavity plus the
residual disease observed in CT/11C-MET-PET/MR images. CTV included the GTV plus 2-cm margin and the PTV was generated
after 0.3–0.5-cm expansion of the CTV. Prescription doses were 70 Gy, 65 Gy and 60 Gy to the 95% of the GTV, CTV and PTV,
