A 41 year old nondiabetic, non hypertensive male was admitted in AHD through neurosurgery OPD with the complaints of left eye watering and left sided weakness for 1 month. MRI examination revealed a mass / lesion in the left prepontine cistern, left CP angle with extension to left middle cranial fossa which was histologically found to be chondroma, an extremely rare tumour in the above mentioned location.
Radiotherapy is an integral part of a well-defined cancer management program. Bangladesh is a fast-growing East Asian country with 161 million population, and approximately 2 lakh cancer patients are diagnosed newly ever year. Though there are several modern treatment facilities to deliver radiotherapy, only limited facilities were available to deliver stereotactic radiotherapy (SRS) programs for needy patients. Evercare Hospitals Dhaka has recently started SRS and stereotactic therapy (SRT) with a dedicated team of trained people. The hospital is equipped with modern linear accelerator capable of delivering high dose rate mode and micro multileaf collimators with 2.45-mm thickness at isocenter to deliver larger doses of radiation precisely. This paper summarizes patient selection criteria and workflow for the SRS/SRT treatment established, including patient preparation, image data acquisition, target and organ at risk delineation on CT (computed tomography) and MRI (magnetic resonance imaging) images, treatment planning process, and quality assurance. Each stage of the process is explained in detail, with specific emphasis on certain areas to achieve a higher degree of accuracy. This article also highlights the need for dedicated timeout procedures to be followed to avoid drastic errors in treatment delivery. We also summarized demographics data of patients treated in the first 6 months, including diagnosis, sizes of lesions, and dose fraction. The dosimetric and setup uncertainties encountered during SRS/SRT treatment delivery are also described. Though, initially, we faced challenges, SRS/SRT treatment was successfully implemented and more than 35 patients were treated, with appreciable clinical outcomes.
Gliosarcoma is a rare primary malignancy of the central nervous system, classified by the World Health Organization as a high-grade glioma and a variant of glioblastoma multiforme. A 57-year-old gentleman presented with a history of left-sided weakness and loss of appetite. Brain MRI was suggestive of right frontal and thalamic mass lesion with contrast enhancement at the periphery. Open biopsy examination revealed a malignant brain tumour presenting a biphasic tissue pattern with gliomatous and mesenchymal components suggestive of gliosarcoma. Although the treatment of gliosarcomas is almost similar to glioblastomas (surgical resection and, depending on clinical status, radiotherapy and/or chemotherapy) the prognosis of gliosarcomas remains poor.
Stereotactic Radiosurgery has been widely utilized for the treatment of intracranial lesions, and this paper presents our experience in treating schwannomas in Bangladesh. This case series was described to present our institutional experience and procedural technique adapted for treating intracranial schwannomas using stereotactic Radiosurgery (SRS) by Linear accelerators. This case series since starting our radiosurgery program in March 2019, we have treated three patients of intracranial schwannoma. Two patients had vestibular schwannoma, and one had Trigeminal Schwannoma. All three patients first underwent surgical intervention and on recurrence/progression treated with stereotactic Radiosurgery. Tumor volume ranged from 4.47 to 10.22 cm3. The dose prescription ranges from 13 to 14Gy in one or two fractions, which was subject to tumor volume, its proximity to a critical structure, existing neurologic deficit, and optimal balance between prescribed dose and predicted complications. All three procedure was free of any immediate adverse event. LINAC based Stereotactic Radiosurgery was found to be a safe and effective option for the treatment of schwannomas. All three patients have a very good clinical outcome, and one patient who has more than one-year post-SRS revealed a significant regression in the size of the tumor. Journal of National Institute of Neurosciences Bangladesh, July 2021, Vol. 7, No. 2, pp. 181-189
Stereotactic radiosurgery (SRS) has been widely used for the treatment of intracranial lesions. We have been doing SRS since March 2019. The unique ability of SRS to deliver higher focused dose to the smaller targets preferably in a single exposure in a convenient manner while sparing adjacent critical structures has made a more widely adopted treatment option. This case series is intended to show our institutional experience and procedural technique adapted for treating intracranial meningioma using SRS by Linear accelerators. We present five cases of intracranial meningioma. Four had Grade I meningioma and one patient with Grade III meningioma. One patient had radiological diagnosis only and treated with SRS. Two patients underwent gross total resection and SRS was prescribed on the event of recurrence. Rest two patients had recurrence/progression after subtotal resection and adjuvant radiation. The dose prescription ranged from 13 to 21Gy in one to three fractions which was determined by tumor volume, location, grade, proximity to critical structures, pre-existing neurologic impairment, previous treatment history, time to progression/relapse and the ideal balance of prescription dosage and expected problems. There were no acute side effects from any of the procedures. All five patients had improvement in clinical symptoms in the immediate post-SRS period. One patient who has two-year post-SRS revealed a significant regression in the size of the tumor. This case series summarizes the fact that SRS for intracranial meningioma is safe and effective treatment strategy when appropriate. Pulse Volume 12-14 2020-2022 p.40-52
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