PMC3794517_01
MRI scan obtained after this patient initially presented to the emergency department demonstrating 4.5 cm, ring-enhancing, left parietal mass with surrounding edema consistent with GBM.
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fig1
His initial MRI scan revealed a single, 4.5 cm, ring-enhancing, left parietal mass with surrounding edema which was consistent with glioblastoma multiforme (GBM) (see Figure 1).
Four months after initial diagnosis, the patient suffered a recurrence of GBM and was treated with GKRS. The prescribed dose was 16 Gy to the 50% isodose line. Tumor volume was measured at 5.2 cubic centimeters.
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fig2
The marginal prescription dose was 16 Gy to the 50% isodose line. 99% of the tumor, at 5.2 cubic centimeters, received at least 16 Gy (see Figure 2).
MRI scan showing increased enhancement, indicating tumor recurrence twenty-two months after GKRS salvage treatment.
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fig3
MRI scans at 17 and 20 months after GKRS treatment revealed a new 2 cm diameter nodule deep to the resection bed with an area of enhancement in the cystic area superficial to that (see Figure 3).
Treatment planning for second salvage GKRS treatment after the second recurrence of GBM. Again, 16 Gy was prescribed to the 50% isodose line.
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fig4
Once again, the prescription dose was 16 Gy to the 50% isodose line and was well tolerated by the patient (see Figure 4).
Treatment planning for one of the three fractions of 7 Gy each to the 50% isodose line (21 Gy total). This was his third and latest salvage GKRS which was administered 46 months after initial diagnosis.
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fig5
He received 3 separate fractions over an 8-day-period with a prescription of 7 Gy per fraction which was well tolerated (21 Gy total dose prescribed to the 50% isodose line, Figure 5).