PMC7186451_01
(A) MRI (T1 postcontrast and T2-FLAIR) showed pseudoprogression at 1 month after radiation therapy and complete radiological response after 1 year. (B) Radiation field photon therapy (25 x 2 Gy). (C) Radiation field proton therapy (5 x 2 Gy RBE).
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F1
Brain magnetic resonance imaging (MRI) demonstrated obstructive hydrocephalus and a ring-enhancing lesion in the right posterior thalamus (Figure 1A). One year after radiation therapy, a complete radiological response was observed (Figure 1A). RapidArc  dose distribution is shown in Figure 1B. PTVprotons, which was encompassed by the 95% isodose level. Proton dose distribution is shown in Figure 1C.
(A) Hematoxylin and eosin-stained section of an anaplastic pleomorphic diffuse infiltrating astrocytic brain tumor (scale bar, 50 mum). (B) Sanger sequencing with evidence of wild-type H3F3A (K27, G34). (C) Representative copy number profile plots showing several chromosomal amplifications and deletions, especially CDKN2A/B deletion.
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F2
Histopathologic examination showed endothelial proliferation and areas of necrosis and resulted in the diagnosis of a GBM [World Health Organization (WHO) grade IV] IDH wild type, H3F3A (K27, G34) HIST1H3B/C and H2H3C wild type, TERT promoter wild type (C228 and C250), KIAA1549-BRAF wild type, and unmethylated MGMT promoter (Figure 2).
Perfusion-MRI. Neither increased CBF (A) nor increased CBV (B) was detectable in the former tumor area 18 months after the end of radiation therapy. In the color-coded pictures, red indicates high blood flow (BF); green indicates moderate BF, and blue indicates low BF.
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F3
Furthermore, a contrast-enhanced perfusion MRI in February 2020 showed reduced cerebral blood flow (CBF) and cerebral blood volume (CBV) in the former tumor area, compared to the contralateral brain hemisphere (Figure 3).