Astrocytoma (WHO Grade III)

Abstract

A 36-year-old female presented with generalized tonic-clonic seizures. She had prior stereotactic biopsy and received conventional radiation therapy (XRT) and Temozolomide for high-grade glioma 5 months ago. The patient was treated with adjunctive; Linac-based SRS for residual (post-XRT and chemotherapy), left, frontal astrocytoma (WHO Grade III). The target volume of 2.1 cc received a marginal dose of 20.0 Gy normalized to 80% isodose line. At 3 months post-SRS, the patient developed contralateral mild hemiparesis, probably attributed to the focal mass effect of tumor pseudo-progression and increased peritumoral vasogenic edema, which required treatment with steroids and diuretics. This neurological deficit resolved completely at 12 months post-SRS, because of marked tumor regression. At 24 months post-SRS, the patient had controlled seizures with anticonvulsant medications, and follow-up MRI showed disappearance of the tumor, appearance of faintly enhancing focal encephalomalacia at the site of prior tumor, in T1 Gadolinium-enhanced study, and marked decrease of perilesional high signal in T2 and FLAIR studies. However, at 96 months post-SRS, the patient developed recurrent contralateral dense hemiparesis because of aggressive tumor recurrence (i.e., failed SRS). At 100 months post-SRS, the patient underwent cytoreductive surgery followed by boost chemotherapy. Despite aggressive management, the patient died, at 110 months post-SRS, from recurrent (post-surgery and chemotherapy) progressive brain tumor.