Proton therapy in the treatment of diffuse astrocytoma of the brain stem. Case report

Abstract

Background. Despite the fact that cerebral astrocytoma belongs to low-grade tumors (grade II gliomas), it often leads to disability and death of patients. The localization of the tumor determines the severity of the clinical symptoms of the disease, which significantly affects its prognosis. The choice of the optimal treatment strategy for astrocytoma localized in the brain stem poses challenges and enables the vast majority of patients to be classified as inoperable. Therefore, radiation therapy or chemoradiotherapy are the main treatment modalities for patients with low-grade glioma. The location of the tumor in close proximity to vital centers makes radiation therapy planning difficult., because the delivery of high doses of radiation can cause serious treatment complications.Description of the clinical case. We present a clinical case of a successful treatment of a young, 20-year-old male patient with diffuse astrocytoma of the brain stem. As radical surgery was impossible to be performed, the patient was offered radiation therapy. The morphology, size, and location of the primary tumor posed challenges for selecting an optimal treatment strategy due to a high risk of damage to vital centers, which could lead to disability and even death of the patient. The use of proton therapy made it possible to deliver the maximum allowable dose of radiation to the tumor, limiting radiation exposure to surrounding healthy tissues. The patient received the complete course of proton therapy. After 36 months of follow-up, no complications and signs of disease progression were found.Conclusion. Despite the high risk of treatment complications, the use of proton therapy made it possible to complete the planned course of treatment, achieve tumor stabilization and significantly improve the life quality of the patient.