Refractory Craniopharyngioma: Successful Treatment with LINAC Based Stereotactic Radiosurgery(SRS): First Case in Nepal

Purpose: To present first case of refractory craniopharyngioma treated successfully with SRS in Nepal.Background: Craniopharyngioma is a benign tumour, which progresses slowly and compresses the pituitary gland and nearby structures. First line of treatment is surgery followed by adjuvant radiotherapy as complete resection is usually not feasible. Here, we are reporting a case of recurrent craniopharyngioma treated with LINAC based SRS.Case Presentation: A 43 years old man diagnosed case of craniopharyngioma in May 2019. He underwent left pterional craniotomy and subtotal resection of tumour and kept on observation. He developed symptomatic as well as radiological recurrence in July 2020. Second debulking was not possible, so we did SRS on 23rd August 2020; 14Gy Dose was delivered to gross tumour volume. Six months after SRS, Patient is doing well.Conclusions: LINAC based SRS is a frameless, non-invasive and safe procedure with excellent clinical outcomes for recurrent or residual craniopharyngioma.

Refractory Craniopharyngioma: Successful Treatment with LINAC Based Stereotactic Radiosurgery (SRS): First Case in Nepal

Purpose: To present first case of refractory craniopharyngioma treated successfully with SRS in Nepal. Bckground: Craniopharyngioma is a benign tumour, which progresses slowly and compresses the pituitary gland and nearby structures. First line of treatment is surgery followed by adjuvant radiotherapy as complete resection is usually not feasible. Here, we are reporting a case of recurrent craniopharyngioma treated with LINAC based SRS. Case Presentation: A 43 years old man diagnosed case of craniopharyngioma in May 2019. He underwent left pterional craniotomy and subtotal resection of tumour and kept on observation. He developed symptomatic as well as radiological recurrence in July 2020. Second debulking was not possible, so we did SRS on 23rd August 2020; 14Gy Dose was delivered to gross tumour volume. Six months after SRS, Patient is doing well. Conclusions: LINAC based SRS is a frameless, non-invasive and safe procedure with excellent clinical outcomes for recurrent or residual craniopharyngioma.

Assessment and Validation of the Internal Gross Tumour Volume of Gastroesophageal Junction Cancer During Simultaneous Integrated Boost Radiotherapy

BackgroundRespiratory motion may introduce errors during radiotherapy. This study aims to assess and validate internal gross tumour volume (IGTV) margins in different regions in gastroesophageal junction (GEJ) tumours during simultaneous integrated boost radiotherapy.MethodsWe enrolled 10 patients in group A and 9 patients in group B. For all patients, two markers were placed at the upper and lower boundaries of tumour before treatment. In group A, within the simulation and every five fractions of radiotherapy, we used 4-dimensional computed tomography (4DCT) to record the intrafractional displacement of the proximal and distal markers. By fusing the average image of each fraction with the simulation image according to the lumbar vertebra, the interfractional displacement could be obtained. We calculated the IGTV margin in the proximal and distal regions of the GEJ tumour. In group B, by referring to the simulation images and cone-beam computed tomography (CBCT) images, the range of tumour displacement in different regions within the GEJ tumour was estimated. We verified the proportion of tumours with marker displacement within the range obtained in group A to estimate the accuracy of the IGTV margin.ResultsThe intrafractional displacement in the cranio-caudal (CC) direction was significantly larger than that in the anterior-posterior (AP) and left-right (LR) directions for both the proximal and distal markers of the tumour. The interfractional displacement in the AP and LR directions was larger than that in the CC direction (p=0.001, p=0.017) according to the distal marker. The IGTV margins for in the LR, AP and CC directions were 9 mm, 8.5 mm and 12.1 mm for proximal marker and 15.8 mm, 12.7 mm and 11.5 mm for distal marker. In group B, the proportions of tumours that fell within the IGTV margin in the LR, AP and CC directions were 96.5%, 91.3% and 96.5% for the proximal marker and 100%, 96.5%, 93.1% for the distal marker.ConclusionsOur study proposed individualized IGTV margins for different regions within GEJ tumours during neoadjuvant radiotherapy. The IGTV margin determined in this study was relatively small and was validated appropriately. It could be a reference in clinical practice.