PMC9294177_01
Relationship between dose of rapamycin and concentration of plasma glucose and rapamycin. Patient received insulin treatment to control plasma glucose on May 15 and from May 25 to August 3, 2021. Patient underwent Ommaya insertion and biopsy on May 13, 2021. Patient underwent subtotal resection of tumor on May 23, 2021. Patient received CPT-SIOP-2000 chemotherapy on July 2 and July 26, 2021. The maintaining trough concentration of rapamycin is recommended between 10 to 15 ng/mL. The figure indicated that patient's concentration of plasma glucose has a positive correlation with the dose of rapamycin.
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August 3 ( Figure 1 ). At present, he is still undergoing chemotherapy and maintains normal plasma glucose and insulin levels, and the residual tumor continues to shrink.
Serial intracranial MR images of the patient. Panel 1 Coronal (A) and transverse (B) T2-weighted MRI of the patient showed the tumor size in the right lateral ventricle and (C, D) MRA displayed the tumor with abundant blood supply (high-signal intensity) at admission (May 4, 2021). Panel 2 Coronal (E) and transverse (F) T2-weighted MRI showed a slight decrease in tumor size and (G, H) MRA displayed significant decrease of blood supply (high-signal intensity) to tumor after 14 days of oral rapamycin treatment (May 21, 2021).
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Computed tomography (CT) and magnetic resonance (MR) images revealed a primary malignant tumor (60.00*84.01*94.72 mm) with a rich blood supply in the right lateral ventricle and metastatic tumors in the left lateral ventricle, the third ventricle, and cerebellopontine angle (CPA) ( Figure 2 ). The MR images showed that the blood supply to the tumor had notably decreased on May 21 after 14 days of rapamycin treatment (the 17th day after admission), while the volume of the tumor in the right lateral ventricle decreased to 56.82*80.06*92.51 mm ( Figure 2 ).