Radiotherapy Protocol of Central Neurocytoma for Resource-limited Settings in the Absence of Official Guidelines: A Case Report and Review of the Literature
DOI:
https://doi.org/10.3889/oamjms.2022.10381Keywords:
Neurocytoma, Radiotherapy, Treatment outcome, CNS neoplasmAbstract
BACKGROUND: Central neurocytoma (CN) is one of the rarest brain tumors which can cause considerable threats to the patient. Studies and trials regarding its treatment are scarce, and no official guidelines are dedicated to this disease. The main principle of treatment generally consists of surgery and radiotherapy. The choice of radiotherapy is divided into conventional fractionated radiotherapy and stereotactic radiosurgery (SRS). However, access to SRS in developing countries such as Indonesia is still limited.
AIM: We report a case delineating the timeline and process of treatment in CN with a review of the literature.
METHODS: We report the case of a 29-year-old woman with a solid inhomogeneous mass (AP 5.63 × CC 5.36 × LL 5.16 cm) in the right ventricle, attached to the septum pellucidum, as displayed on the magnetic resonance imaging (MRI). The patient had been vomiting for the past three weeks and presented with bidirectional horizontal nystagmus.
RESULTS: Cognitive evaluation with Montreal Cognitive Assessment (MoCA-Ina) demonstrated a mild cognitive impairment. Biopsy was performed, and pathology analysis revealed some cells with fibrillary background and some with a honeycomb-like appearance. The immunohistochemistry staining showed positive results with synaptophysin and neuronal nuclear protein. According to the WHO classification of the central nervous system tumors, the profile favored CN Grade II. Subtotal resection (STR) was performed to reduce the tumor mass, which was measured with MRI 2-month post-surgery (AP 4.09 × CC 3.01 × LL 4.13 cm) and then followed by an external radiation program. Using intensity modulated radiation therapy (IMRT), a total dose of 54 Gy was given in 27 fractions, with the average planning target volume of 54.3 Gy. There was a minuscule reduction in tumor mass as seen in post-radiotherapy MRI (AP 4.00 × CC 3.86 × LL 3.63 cm). After the last session and at the 18-month follow-up, the patient did not have any complaints or abnormalities during clinical assessment. Reevaluation using MoCA-Ina showed an improved cognitive function.
CONCLUSIONS: In line with recent evidence, we demonstrated that STR followed by IMRT with the dosage of 54 Gy in 27 fractions was a feasible treatment strategy for CN that resulted in cognitive improvement, with no side effects.Downloads
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Chen H, Zhou R, Liu J, Tang J. Central neurocytoma. J Clin Neurosci. 2012;19(6):849-53. https://doi.org/10.1016/j.jocn.2011.06.038 PMid:22537657 DOI: https://doi.org/10.1016/j.jocn.2011.06.038
Hassoun J, Gambarelli D, Grisoli F, Pellet W, Salamon G, Pellissier JF, et al. Central neurocytoma. An electron-microscopic study of two cases. Acta Neuropathol. 1982;56(2):151-6. https://doi.org/10.1007/BF00690587 PMid:7064664 DOI: https://doi.org/10.1007/BF00690587
Board WCoTE. World Health Organization Classification of Tumours of the Central Nervous System. 5th ed. Lyon: International Agency for Research on Cancer; 2021.
Wang M, Zhou P, Zhang S, Liu X, Lv L, Wang Z, et al. Clinical features, treatment, and long-term outcomes of central neurocytoma: A 20-year experience at a single center. World Neurosurg. 2018;109:e59-66. https://doi.org/10.1016/j.wneu.2017.09.103 PMid:28958923 DOI: https://doi.org/10.1016/j.wneu.2017.09.103
Pannullo SC, Julie DA, Chidambaram S, Balogun OD, Formenti SC, Apuzzo ML, et al. Worldwide access to stereotactic radiosurgery. World Neurosurg. 2019;130:608-14. https://doi.org/10.1016/j.wneu.2019.04.031 PMid:31581410 DOI: https://doi.org/10.1016/j.wneu.2019.04.031
Indonesian Radiation Oncology Society (IROS). Roadmap of Radiotherapy Development in Indonesia. Jakarta: Indonesian Radiation Oncology Society; 2018.
Hallock A, Hamilton B, Ang LC, Tay KY, Meygesi JF, Fisher BJ, et al. Neurocytomas: Long-term experience of a single institution. Neuro Oncol. 2011;13(9):943-9. https://doi.org/10.1093/neuonc/nor074 PMid:21824889 DOI: https://doi.org/10.1093/neuonc/nor074
Dutta SW, Kaleem TA, Muller DA, Peterson J, Harrell AC, Quinones-Hinojosa A, et al. Central neurocytoma: Clinical characteristics, patterns of care, and survival. J Clin Neurosci. 2018;53:106-11. https://doi.org/10.1016/j.jocn.2018.04.015 PMid:29685410 DOI: https://doi.org/10.1016/j.jocn.2018.04.015
Yang I, Ung N, Chung LK, Nagasawa DT, Thill K, Park J, et al. Clinical manifestations of central neurocytoma. Neurosurg Clin N Am. 2015;26(1):5-10. https://doi.org/10.1016/j.nec.2014.09.011 PMid:25432178 DOI: https://doi.org/10.1016/j.nec.2014.09.011
Patel DM, Schmidt RF, Liu JK. Update on the diagnosis, pathogenesis, and treatment strategies for central neurocytoma. J Clin Neurosci. 2013;20(9):1193-9. https://doi.org/10.1016/j.jocn.2013.01.001 PMid:23810386 DOI: https://doi.org/10.1016/j.jocn.2013.01.001
Li J, Recinos PF, Orr BA, Burger PC, Jallo GI, Recinos VR. Papillary tumor of the pineal region in a 15-month-old boy: Case report. J Neurosurg Pediatr. 2011;7(5):534-8. https://doi.org/10.3171/2011.2.PEDS10434 PMid:21529195 DOI: https://doi.org/10.3171/2011.2.PEDS10434
Chen CL, Shen CC, Wang J, Lu CH, Lee HT. Central neurocytoma: A clinical, radiological and pathological study of nine cases. Clin Neurol Neurosurg. 2008;110(2):129-36. https://doi.org/10.1016/j.clineuro.2007.09.023 PMid:18022760 DOI: https://doi.org/10.1016/j.clineuro.2007.09.023
Shin JH, Lee HK, Khang SK, Kim DW, Jeong AK, Ahn KJ, et al. Neuronal tumors of the central nervous system: Radiologic findings and pathologic correlation. Radiographics. 2002;22(5):1177-89. https://doi.org/10.1148/radiographics.22.5.g02se051177 PMid:12235346 DOI: https://doi.org/10.1148/radiographics.22.5.g02se051177
Jaiswal S, Vij M, Rajput D, Mehrotra A, Jaiswal AK, Srivastava AK, et al. A clinicopathological, immunohistochemical and neuroradiological study of eight patients with central neurocytoma. J Clin Neurosci. 2011;18(3):334-9. https://doi.org/10.1016/j.jocn.2010.05.031 PMid:20869874 DOI: https://doi.org/10.1016/j.jocn.2010.05.031
Bonney PA, Boettcher LB, Krysiak RS, Fung KM, Sughrue ME. Histology and molecular aspects of central neurocytoma. Neurosurg Clin N Am. 2015;26(1):21-9. https://doi.org/10.1016/j.nec.2014.09.001 PMid:25432180 DOI: https://doi.org/10.1016/j.nec.2014.09.001
Kane AJ, Sughrue ME, Rutkowski MJ, Tihan T, Parsa AT. The molecular pathology of central neurocytomas. J Clin Neurosci. 2011;18(1):1-6. https://doi.org/10.1016/j.jocn.2010.06.004 PMid:20884210 DOI: https://doi.org/10.1016/j.jocn.2010.06.004
Sim FJ, Keyoung HM, Goldman JE, Kim DK, Jung HW, Roy NS, et al. Neurocytoma is a tumor of adult neuronal progenitor cells. J Neurosci. 2006;26(48):12544-55. https://doi.org/10.1523/JNEUROSCI.0829-06.2006 PMid:17135416 DOI: https://doi.org/10.1523/JNEUROSCI.0829-06.2006
Lee SJ, Bui TT, Chen CH, Lagman C, Chung LK, Sidhu S, et al. Central neurocytoma: A review of clinical management and histopathologic features. Brain Tumor Res Treat. 2016;4(2):49-57. https://doi.org/10.14791/btrt.2016.4.2.49 PMid:27867912 DOI: https://doi.org/10.14791/btrt.2016.4.2.49
Rades D, Schild SE. Treatment recommendations for the various subgroups of neurocytomas. J Neuro Oncol. 2006;77(3):305-9. https://doi.org/10.1007/s11060-005-9047-3 PMid:16575540 DOI: https://doi.org/10.1007/s11060-005-9047-3
Han S, Yang Z, Yang Y, Qi X, Yan C, Yu C. Individual treatment decisions for central neurocytoma. Front Neurol. 2020;11:834. https://doi.org/10.3389/fneur.2020.00834 PMid:32922351 DOI: https://doi.org/10.3389/fneur.2020.00834
Choudhari KA, Kaliaperumal C, Jain A, Sarkar C, Soo MY, Rades D, et al. Central neurocytoma: A multi-disciplinary review. Br J Neurosurg. 2009;23(6):585-95. https://doi.org/10.3109/02688690903254350 PMid:19922271 DOI: https://doi.org/10.3109/02688690903254350
Leenstra JL, Rodriguez FJ, Frechette CM, Giannini C, Stafford SL, Pollock BE, et al. Central neurocytoma: Management recommendations based on a 35-year experience. Int J Radiat Oncol Biol Phys. 2007;67(4):1145-54. https://doi.org/10.1016/j.ijrobp.2006.10.018 PMid:17187939 DOI: https://doi.org/10.1016/j.ijrobp.2006.10.018
Barani IJ, Raleigh DR, Larson D. The management of central neurocytoma: Radiotherapy. Neurosurg Clin. 2015;26(1):45-56. https://doi.org/10.1016/j.nec.2014.09.014 PMid:25432183 DOI: https://doi.org/10.1016/j.nec.2014.09.014
Samhouri L, Meheissen MA, Ibrahimi AK, Al-Mousa A, Zeineddin M, Elkerm Y, et al. Impact of adjuvant radiotherapy in patients with central neurocytoma: A multicentric international analysis. Cancers. 2021;13(17):4308. https://doi.org/10.3390/cancers13174308 PMid:34503124 DOI: https://doi.org/10.3390/cancers13174308
Garcia RM, Ivan ME, Oh T, Barani I, Parsa AT. Intraventricular neurocytomas: A systematic review of stereotactic radiosurgery and fractionated conventional radiotherapy for residual or recurrent tumors. Clin Neurol Neurosurg. 2014;117:55-64. https://doi.org/10.1016/j.clineuro.2013.11.028 PMid:24438806 DOI: https://doi.org/10.1016/j.clineuro.2013.11.028
Mahavadi AK, Patel PM, Kuchakulla M, Shah AH, Eichberg D, Luther EM, et al. Central neurocytoma treatment modalities: A systematic review assessing the outcomes of combined maximal safe resection and radiotherapy with gross total resection. World Neurosurg. 2020;137:e176-82. https://doi.org/10.1016/j.wneu.2020.01.114 PMid:32001392 DOI: https://doi.org/10.1016/j.wneu.2020.01.114
Rades D, Schild SE, Ikezaki K, Fehlauer F. Defining the optimal dose of radiation after incomplete resection of central neurocytomas. Int J Radiat Oncol Biol Phys. 2003;55(2):373-7. https://doi.org/10.1016/s0360-3016(02)03918-4 PMid:12527050 DOI: https://doi.org/10.1016/S0360-3016(02)03918-4
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Copyright (c) 2022 Dion Firli Bramantyo, Diaza Okadimar Ariyanto, Krisna Tsaniadi Prihastomo, Rahmi Ardhini, Muhammad Murtadho, Christina Hari Nawangsih Prihharsanti (Author)
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