Neurological Cancer
Figure 1: Magnetic Resonance Image of Brain T1 + Contrast
Glioma of left frontal lobe.
Figure 2: Magnetic Resonance Image of Spine T1 + Contrast
oedema and midline shift (see Figure 1). She underwent craniotomy and subtotal resection and histopathology demonstrated a World Health Organization (WHO) grade 3 glioma. She received post-operative radiotherapy to a dose of 54 Gy in 30 fractions followed by four cycles of PCV chemotherapy, which was completed in June 2003; an MRI brain scan post treatment showed residual disease. In November 2003, she attended her GP surgery complaining of pain in her left buttock and leg with associated bilateral leg weakness but with no sensory level and no disturbance of bowel or bladder function. MRI scan of brain and spine showed stable intracerebral disease but several intradural metastases in the thoracolumbar spinal region (see Figure 2). Histopathological confirmation was not sought and she underwent a course of palliative radiotherapy planned to the thoracolumbar spine to a total dose of 50 Gy over five weeks. Pain and leg weakness initially responded; however, radiotherapy was discontinued after 14 fractions due to pancytopenia. Her leg weakness deteriorated following this and she died from progressive disease in January 2004, one month after the diagnosis of intraspinal metastases.
Case 3
Glioma of left frontal lobe intradural thoracolumbar metastases. Figure 3: Magnetic Resonance Image of Brain T2
This 44-year-old woman presented with light-headedness in November 2004. She received an MRI brain scan in March 2005 that revealed a left inferior frontal and medial temporal lobe lesion compatible with a glioma (see Figure 3). Histopathology from a stereotactic biopsy in March 2005 demonstrated a WHO grade 3 astrocytoma. She underwent radical radiotherapy, followed by four cycles of PCV chemotherapy that she completed in December 2005.
Figure 4: Spine Magnetic Resonance Image T1 + Contrast Left medial frontal lobe astrocytoma.
Routine MRI scan on completion of treatment demonstrated a new lesion in the contralateral right temporal lobe, within the previous radiotherapy treatment field and she underwent chemotherapy with temozolamide, completing six cycles of treatment in July 2006. MRI scan following six cycles demonstrated a partial response. She began complaining of lower back pain in November 2006 and was admitted to a local hospice in January 2007, her general condition having deteriorated significantly. She had bilateral lower limb weakness and numbness. Cerebrospinal MRI scan revealed diffuse meningeal involvement (see Figure 4) throughout the thoracolumbar spine but stable intracerebral disease and due to her frailty, no histological confirmation was sought. Her condition deteriorated further and she died in February 2007, less than one month following diagnosis of intraspinal disease; she did not undergo specific treatment for the spinal disease due to her poor general condition.
Case 4 Diffuse spinal meningeal metastases.
was observed and bladder function returned to normal. These effects lasted for one month when his condition deteriorated and he noticed worsening leg weakness and bladder function. He was managed with best supportive care and died in January 1998, two months following completion of radiotherapy.
Case 2
In August 2002, this 55-year-old woman was admitted to hospital with a one-month history of expressive dysphasia and right facial, arm and leg weakness. Brain MRI scan demonstrated a 6 cm cystic mass structure in the left frontal lobe associated with surrounding
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This 45-year-old man presented in September 2008 with headaches, dysarthria and unsteadiness. MRI brain scan demonstrated a left temporal lobe tumour (see Figure 5) and he underwent subtotal debulking. Histopathological examination revealed a GBM (WHO grade IV). Adjuvant external beam radiotherapy with 60 Gy in 30 fractions with concurrent temozolamide was completed in December 2008. On completion, the patient’s condition deteriorated, developing headaches with right-sided arm and leg weakness. Repeat MRI scan in January demonstrated an increase in the tumour volume and therefore, the planned sequential chemotherapy with temozolamide was converted to PCV chemotherapy. Further MRI scan post-cycle three PCV showed a reduction in the temporal lobe tumour mass. In June 2009, the patient began complaining of lower back pain with associated bilateral proximal lower limb weakness but normal
EUROPEAN ONCOLOGY & HAEMATOLOGY
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