Martinez-Moreno Mauricio, Galván de la Cruz Olga O, Flores-Balcázar Christian H, Rosales-Pérez Samuel, Rembao-Bojórquez Daniel, Moreno-Jiménez Sergio
Neurosurgery, HELIOS Ostseeklinik Damp.
Radioneurosurgery Unit, National Institute of Neurology and Neurosurgery.
Cureus. 2018 Feb 8;10(2):e2170. doi: 10.7759/cureus.2170.
Supratentorial relapses are a common component of medulloblastoma after failure of treatment. Craniospinal irradiation (CSI) to cerebrospinal fluid-bearing areas is an essential part of the management of these tumors both in adults and children. Failure of treatment in specific anatomical regions can be attributable to technical inaccuracies in CSI technique leading to radiation underdosing in such areas. We present two cases of patients with bilateral simultaneous metastasis of a primary medulloblastoma treated, in both cases, four years before the recurrence. In both patients the tumors were mirror images, at the right and left temporal pole. Radiotherapeutic plans were analyzed in both cases, and a possible mechanism determining the pattern of relapse is discussed. We consider, in agreement with the literature, that a prone position during treatment, shielding blocks at the cribiform/subfrontal region, and anatomic inadequacies in the CSI fields could have contributed to the presented pattern of relapse.
幕上复发是髓母细胞瘤治疗失败后的常见情况。对含脑脊液区域进行全脑脊髓照射（CSI）是成人和儿童这些肿瘤治疗的重要组成部分。特定解剖区域的治疗失败可能归因于CSI技术的技术不准确，导致这些区域的放射剂量不足。我们报告两例原发性髓母细胞瘤双侧同时转移的患者，这两例患者在复发前四年均接受过治疗。在这两名患者中，肿瘤均位于左右颞极，呈镜像对称。分析了两例患者的放射治疗计划，并讨论了决定复发模式的可能机制。与文献一致，我们认为治疗期间的俯卧位、筛状/额下区域的屏蔽块以及CSI野的解剖学不足可能导致了所呈现的复发模式。
