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Usefulness of neoadjuvant brachytherapy in the treatment of pineoblastoma:a case report Eiji TADA 1 , Kengo MATSUMOTO 1 , Susumu TOMITA 1 , Tomohisa FURUTA 1 , Takashi OHMOTO 1 1Department of Neurological Surgery, Okayama University Medical School Keyword: pineal cell tumor , pineoblastoma , chemotherapy , brachytherapy , surgery pp.481-485
Published Date 1996/5/10
DOI https://doi.org/10.11477/mf.1436901216
  • Abstract
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The treatment strategy and prognosis of pineal cell tumors are still subjects of debate because of their rar-ity and the mixture of pineoblastoma and pineocytoma as components. Pineoblastoma is believed to be the more malignant tumor and total gross resection of this tumor is very difficult because of its invasive tendency and location. Although the effectiveness of external irradiation and chemotherapy has been reported, the outlook for patients with this tumor is extremely poor.

We treated a case of pineoblastoma with a single to-tal resection nine months after interstitial irradiation and chemotherapy. In this case, brachytherapy was success-ful as neoadjuvant therapy for decreasing the tumor's volume and clarifying its boundary.

The patient was a 36-year-old woman who had com-plained of occipital headache for about a month. On admission, neurological examination revealed bilateral papilloedema but, otherwise, there were no deficits. A magnetic resonance image (MRI) showed a homogene-ously enhanced tumor in the pineal region and obstruc-tive hydrocephalus. Two weeks after ventri-culo-peritoneal shunting, a stereotactic needle biopsy was performed using a BRW MRI-guided stereotactic apparatus, and three catheters for interstitial brachytherapy were implanted into the tumor through the biopsy tract. Iridium-192 seeds were inserted through the catheters and kept there for 8 days to irradiate 40 Gy at the tumor periphery. Four courses of chemotherapy with carboplatin (400mg/m2) and VP-16 (400mg/m2) were administered after brachytherapy. Repeat MRI scans every month showed a gradual re-gression of tumor volume. However, the tumor did not disappear and no further decrease in tumor volume was observed 8 months after brachytherapy. A suboccipital craniotomy was performed 9 months after brachyther-apy and en bloc tumor resection was achieved readily via an infratentorial supracerebellar approach. After re-ceiving another course of chemotherapy and external irradiation at 40 Gy, the patient was discharged with-out any symptoms and no residual tumor or recurrence was observed for 24 months after brachytherapy and 15 months after surgery.

The clinical course of this case suggests that a com-bination of stereotactic biopsy and brachytherapy with chemotherapy followed by surgery may be a good strategy for the treatment of pineal cell tumors regard-less of their histopathological features.


Copyright © 1996, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院

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