Mou Benjamin, Cruz-Lim Ella Mae
Department of Radiation Oncology, BC Cancer, Kelowna, CAN.
Cureus. 2023 Feb 7;15(2):e34732. doi: 10.7759/cureus.34732. eCollection 2023 Feb.
A 32-year-old man with medulloblastoma was initially treated with subtotal resection and craniospinal irradiation. He developed recurrent metastatic disease three years later with extensive bone-only metastases. Biopsy of the bone lesions confirmed metastatic medulloblastoma and restaging investigations demonstrated a superscan with no evidence of recurrence in the craniospinal axis. Extraneural metastatic medulloblastoma is rare, and the presentation with diffuse bone-only metastases with a superscan on imaging is unique. The patient had diffusely painful bone metastases requiring multiple hospitalizations for poor pain control. He declined chemotherapy and was treated with radium-223, an alpha particle emitting radionuclide therapy typically used in metastatic castrate-resistant prostate cancer. The patient received three out of a planned six cycles of radium-223 before it was discontinued due to myelosuppression requiring multiple blood transfusions, and restaging demonstrated local recurrence in the posterior fossa. This is the first report to our knowledge describing the use of radium-223 in a patient with extraneural bone-only metastatic medulloblastoma. Further research into the effect of radium-223 in patients with diffuse bone-only metastases from non-prostate cancer primary tumors is warranted.
一名32岁的髓母细胞瘤男性患者最初接受了次全切除和颅脊髓照射治疗。三年后，他出现了复发性转移性疾病，仅伴有广泛的骨转移。骨病变活检证实为转移性髓母细胞瘤，重新分期检查显示为超级扫描，颅脊髓轴无复发迹象。髓母细胞瘤的神经外转移罕见，影像学表现为仅弥漫性骨转移伴超级扫描的情况独特。该患者有弥漫性疼痛性骨转移，因疼痛控制不佳多次住院。他拒绝化疗，接受了镭-223治疗，这是一种通常用于转移性去势抵抗性前列腺癌的发射α粒子的放射性核素治疗。该患者在计划的六个周期镭-223治疗中接受了三个周期，之后因骨髓抑制需要多次输血而停药，重新分期显示后颅窝局部复发。据我们所知，这是首例描述镭-223用于仅发生神经外骨转移的髓母细胞瘤患者的报告。有必要进一步研究镭-223对非前列腺癌原发肿瘤仅发生弥漫性骨转移患者的疗效。
