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Jostpille
Patient History
8/20/2014
Esophagogastroduodenoscopy (Egd diagnostic)
11/2/2016
Craniotomy (bilateral)
Social and Family History
10/31/16
Patient had been having memory loss and loss of appetite for 3-4 months.
Patient presented to ED after episodes of nausea and vomiting.
10/31/16
MRI brain shows 6.6 x 7.6 large enhancing, hypervascular, with significant
mass effect.
11/2/16
Bifrontal resection of tumor. Pathology was diagnosed.
11/3/16
MRI showed the new post surgical changes involving the anterior frontal
region and the large mass has been resected.
11/15/16
Recommended to rad onc due to high Ki-67 proliferation rate of 16%.
Common Presenting Signs of Meningioma
Mental changes, personality changes and changes in behavior are often 1st
noticed by family or friends.
Sudden onset of symptoms may indicate a tumor of higher grade and size.
Symptoms of long duration may indicate a slow growing tumor.
Invasion, irritation, and compression of the brain by the tumor cause these
symptoms.
Epidemiology
Approximately 23,130 new CNS tumors (brain and spinal cord) are diagnosed
annually in the US and result in approximately 14,080 deaths in 2013.
Brain tumors account for 1.5-2% of the newly diagnosed tumors/year.
Meningioma’s occur around 60 years old.
2:1 women to men ratio
Common Etiology
WHO Grade I
Meningioma of bifrontal region
Spindle cell neoplasm with frequent macronucleoli with no brain invasion
Mesenchymal neoplasm with focal necrosis
Mass of tumor was 6.6 x 7.6
Benign (90%)
Meningothelial, fibrous (fibroblastic), transitional, psammomatous, and angioblastic
Atypical (7%)
Chordoid, clear cell, atypical
Anaplastic/Malignant (2%)
Papillary, rhabdoid, and anaplastic
WHO Grading Scale
Grade I
• These tumors are regarded as benign, or non-cancerous, though they may slowly grow. Their
cells appear close to normal under a microscope. The borders of the tumor are distinct. Benign
tumors can cause problems when they compress the brain. Grade I tumors are rare in adults,
and are associated with long-term survival.
Grade II
• These slowly-growing tumors may spread to nearby tissue. Their cells appear slightly abnormal
under a microscope. Grade II tumors may return as a more aggressive tumor after therapy.
Grade III
• These tumors are considered malignant, or cancerous. The cells are abnormal and reproducing, with
spread into healthy brain tissue. Grade III tumors are likely to recur, coming back as a more
aggressive tumor.
Grade IV
• These aggressive tumors are the most serious because of their rapid growth and spread. The cells
are very abnormal, and the tumor creates new blood vessels as it grows. Grade IV tumors may have
a core of dead cells (necrosis).
Lymphatics
Surgery is the most common treatment and most often the only treatment
Cancerous tumors includes radiation therapy and/or chemotherapy after surgery
Craniotomy
Radiation therapy includes methods of VMAT, IMRT, SRS, SRT, conformal,
gamma knife, cyber knife, or proton therapy
Chemotherapy must use agents that cross the blood brain barrier
Lipid-soluable
BCNU, lomustine, streptozocin
Mylosuppresion
MRI pre surgery MRI post surgery
Treatment Plan
6mv
V-mat / 3 arcs
5400 in 180 cGy
30 fractions
Primary Brain Treatment Borders
Supine
Shims: 1mm x 2
Q2 + custom headrest
Aquaplast mask shoulder mask
Hands on chest
Knee sponge
Critical Structures
Potential Side Effects
Fatigue
Skin reaction –dryness, erythema, itchiness, blistering
Loss of hair
Possible difficulties in concentration and/or short term memory
Possible sense of fullness in the ears
Possible nausea, vomiting, and/or headache
Possible brain swelling
Possible hearing loss/loss of vision
Possible decreased hormone levels needing replacement
Possible damage to brainstem/spinal cord leading to paralysis/debilitation
Possible loss of strength of extremities
Possible cataracts
Disease Prognosis and Survival