Chemoradiation Treatment of Brainstem Glioma. Features of Physical and Dosimetric Planning (A Clinical Case)

Introduction. Brainstem gliomas are associated with the median overall survival of 6–16 months. The available treatment approaches have not shown significant improvement in survival rate, which makes the search for improved strategies particularly relevant. Materials and methods. In Radiotherapy Unit No. 1 of the Voronezh Regional Scientific and Clinical Oncology Center, a patient with a clinical and radiological diagnosis of glioma grade 4 of the right thalamus, posterior limb of the internal capsule, and right cerebral peduncle was treated. Treatment strategy: conventional radiotherapy to 60 Gy with temozolomide 75 mg/m² /day. Results. The prescribed dose for the affected area outside the brainstem was 60 Gy, including the brainstem — 56 Gy. The treatment was tolerated well. No toxicity or neurological deficit progression was observed. Discussion. According to most scientific publications, radiation therapy with 54 Gy is a confirmed thera‑ peutic option in the treatment of brainstem gliomas. Some studies showed the possibility of increasing the maximum tolerant dose to the brainstem to 64 or 69.59 Gy. Therefore, the selected prescribed dose in the considered clinical case appears underestimated. However, during the planning process, the task was set to achieve a uniform dose distribu‑ tion. In the future, in cases of primary brainstem formations, it seems advisable to use 58 Gy as the prescribed dose. Conclusion. In the clinical case under consideration, the delivery of the prescribed 56–60 Gy dose to the main volume of brainstem glioma is possible, taking into account the existing tolerance criteria with the achievement of satisfactory dose coverage and the absence of development of serious neurological complications.

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