Esthesioneuroblastoma – delayed postoperative radiosurgery for recurrence at long-term
Skull Base Region
Olfactory Groove
Histopathology
Esthesioneuroblastoma
Prior Surgical Resection
Yes
Pertinent Laboratory Findings
N/A
Case description
The patient was a 40-year-old male who presented with a 1-year history of intermittent nasal obstruction. Progressive symptoms led to a transnasal biopsy demonstrating esthesioneuroblastoma. He underwent a craniofacial resection with negative margins for a Kadish stage C, Hyams grade 3 tumor and received adjuvant radiation of 5040 cGy in 28 fractions along with Cytoxan, etoposide, and cisplatin chemotherapy ( Figure 2.6.1 ). He was followed with positron emission tomography (PET) and magnetic resonance imaging (MRI), demonstrating recurrent local disease 7 years later ( Figure 2.6.2 ). Due to the presence of other medical comorbidities, he underwent stereotactic radiosurgery (SRS) treatment for recurrence (7 isocenters; volume, 38.4 cm 3 ; 10-Gy margin; 25-Gy maximum dose) ( Figure 2.6.3 ).
Radiosurgery Machine
Gamma Knife – Model B
Radiosurgery Dose (Gy)
10, at 50% isodose line
Number of Fractions
1
Figure 2.6.1.
Initial postoperative axial postcontrast T1-weighted image after adjuvant radiotherapy.
Figure 2.6.2.
Interval axial postcontrast T1-weighted image at 7 years demonstrating local disease recurrence.
Figure 2.6.3.
Imaging of the treatment plan.
Critical Structure
Dose Tolerance
Optic nerve/chiasm
10 Gy maximum point dose
<0.2 cc >8 Gy
Cavernous carotid artery
Tolerant, no evidence of SRS-induced stenosis
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Apr 6, 2024 | Posted by drzezo in GENERAL RADIOLOGY | Comments Off on Esthesioneuroblastoma – delayed postoperative radiosurgery for recurrence at long-term
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