title: Brain dose-sparing radiotherapy techniques for localized intracranial germinoma: Case report and literature review of modern irradiation.
abstract: We examined the effects of intensity-modulated radiation therapy with dose-sparing and avoidance technique on a pediatric patient with localized intracranial germinoma. We also reviewed the literature regarding modern irradiation techniques in relation to late neurocognitive sequelae. A patient with a localized intracranial germinoma in the third ventricle anterior to the pineal gland received a dose-sparing intensity-modulated radiation therapy. The planning was compared to the radiation oncologist's guide of organs at risk and dose constraints for dosimetric analyses. The patient received radiation therapy alone. The total dose was 54Gy delivered in 2.0Gy fractions to the primary tumour and 37Gy in 1.4Gy fractions to whole ventricles using a dose-sculpting plan. Dosimetry analyses showed that dose-sparing intensity-modulated radiation therapy delivered reduced doses to the whole brain, temporal lobes, hippocampi, cochleae, and optic nerves. With a follow-up of 22 months, failure-free survival was 100% for the patient and no adverse events during radiation treatment process. Intensity-modulated radiation therapy with dose sparing and avoidance technique can spare the limbic circuit, central nervous system, and hippocampus for pineal germ cell tumours. This technique reduces the integral dose delivered to the uninvolved normal brain tissues and may reduce late neurocognitive sequelae caused by cranial radiotherapy.
authors.affiliation: Department of radiation therapy, An Nan hospital, China Medical University, No. 66, Sec. 2, Changhe road, Annan Dist, 71710 Tainan, Taiwan; Department of information management, Chia Nan university of pharmacy and science, No. 60, Sec. 1, Erren road, Rende Dist, 71710 Tainan, Taiwan.
authors.forename: H W C
authors.initials: HW
authors.lastname: Leung
authors.affiliation: Department of pharmacy, An Nan hospital, China Medical University, No. 66, Sec 2, Changhe road, Annan Dist, 71710 Tainan, Taiwan. Electronic address: agnes.lf@gmail.com.
authors.forename: A L F
authors.initials: AL
authors.lastname: Chan
authors.affiliation: Department of radiation therapy, An Nan hospital, China Medical University, No. 66, Sec. 2, Changhe road, Annan Dist, 71710 Tainan, Taiwan.
authors.forename: M B
authors.initials: MB
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D001932:Brain Neoplasms / Q000532:radiotherapy*; D018237:Germinoma / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D059351:Organ Sparing Treatments; D011874:Radiometry; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*
keywords: Germinome du système nerveux central localisé; Localized CNS germinoma; OAR; Organes à risque; Radiotherapy; Radiothérapie