Safety and Efficacy of Stereotactic Radiosurgery in the Management of Primary Spinal Cord Glioblastoma: A Case Report

Abstract

Grazia Lazzari,1 Antonietta Montagna,1 Ilaria Benevento,1 Barbara D’Andrea,1 Vito Metallo,1 Raffaele Tucciariello,2 Antonio Colamaria,3 Giuseppe Di Perna,3 Pasqualina Modano,4 Antonella Bianculli2 1Radiation Oncology Unit - IRCCS-CROB, Rionero in Vulture, PZ, 85028, Italy; 2Physic Unit - IRCCS-CROB, Rionero in Vulture, PZ, 85028, Italy; 3Neurosurgery Unit- Ospedali Riuniti -Policlinico Universitario, Foggia, FG, 71121, Italy; 4Emergency and Palliative Care Unit- IRCCS-CROB, Rionero in Vulture, PZ, 85028, ItalyCorrespondence: Grazia Lazzari, Radiation Oncology Unit. IRCCS-CROB; Rionero in Vulture, PZ, Italy, Tel [phone] ; + 39 0972 726741, Email [email protected]: Primary spinal cord Glioblastoma multiforme (IV grade WHO), also known as Primary Spinal Cord Astrocytoma (SCA), accounts for 6– 8% of primary spinal cord tumors and up to 1.5% of all spinal cord tumors. However, owing to their rarity, no large studies or management consensus are available. Gross total resection (GTR) is the best advisable approach; however, in primary spinal tumors, this procedure is not always safe or feasible. Higher radiation doses with conventional radiotherapy (RT) are limited by the spinal cord’s radiation tolerance. Stereotactic radiosurgery (SRS) is an effective and safe alternative when administered with adequate real-time simulation and planning to minimize setup errors with risks to the normal spinal cord.Case Presentation: Herein we present the case of a 32-year-old woman with primary grade IV glioblastoma (GBM) of the spinal cord at cervical C3-C6 (C3–C6) vertebrae level who underwent subtotal resection. The patient presented with neurological impairment in the neck, shoulder, and limbs. Sphincteric dysfunction and hyperaesthesia on the chest were also recorded. As adjuvant therapy, SRS with a dose of 14 Gy to the PTV was administered, ensuring a Dmax of 12 Gy to the spinal cord. Patient was treated in the same day of simulation and planning; hence, no set-up discrepancies were recorded on Cone Beam CT (CBCT) images during the RT delivery. Two days after SRS, the patient’s neurological symptoms improved with recovery of neck and shoulder motor functions followed by weak upper limb activity. Afterwards, 6 cycles of temozolomide were administered.Conclusion: We described a case of grade IV glioblastoma multiforme after partial resection, that was safely treated with adjuvant SRS in real-time with simulation and planning. This modality could improve the safety of SRS in the treatment of such tumors.Keywords: adjuvant therapy, glioblastoma, stereotactic radiosurgery, primary spinal cord tumors

Keywords

• adjuvant therapy
• glioblastoma
• stereotactic radiosurgery
• primary spinal cord tumors