Hyperfractionated cranio-spinal irradiation in the complex treatment of inoperable pinealoblastoma in childhood
L. Marinova, I. Mihaylova, R. Georgiev
We present a rare case of brain pineal neoplasm in 14 years old girl – pinealobastoma – brain primitive neuroectodermal tumor (PNET). The tumor in the pineal region causes occlusive hydrocephaly, not cured following ventriculostomy of the 3rd ventricle. After liquor-draining valve (ventriculoperitoneal drain) was applied hyperfractionated cranio-spinal irradiation (cranio-spinal irradiation), which was needed due to the high risk of leptomeningeal and spinal liquor metastases. Unfavorable prognosis requires postoperative hyperfractionated cranio-spinal irradiation twice daily whit daily dose of 1,5 Gy in 6 hours interval to total dose of 36 Gy in CNS and spinal; at second step boost – hyperfractionated in 6 hours interval to total dose 48 Gy in the ventricles and of 58-60 Gy in pineal tumor. In addition to cranio-spinal irradiation was applied Dexometasone 1 amp. daily i.m. and Ecomer 3 х 1-2 caps. daily per os. Hyperfractionated cranio-spinal irradiation was required in pinealobastoma with hydrocephaly, followed by chemotherapy after ventriculo-peritoneal liquor drain and biopsy. This complex treatment approach significantly improves free of disease survival through minimization of local leptomeningeal and spinal recurrences.
Key words: PINEALOBASTOMA IN CHILDHOOD. PNET. HYPERFRACTIONATED CRANIO-SPINAL IRRADIATION. COMPLEX TREATMENT CHEMOTHERAPY