CLINICAL DATA
A four-year-old female patient presented with a posterior fossa tumour with a year history of postprandial vomiting, headaches, partial vision loss and inability to walk. A biopsy revealed it to be classic medulloblastoma. A VP shunt was inserted and mass excision was performed to debulk the tumour.
IMAGING AND PATHOLOGY
Post craniotomy, an MRI and CT scan revealed a residual tumour measuring (1.6x 3.2 x 2.0) cm with no leptomeningeal or spinal drop lesions. The patient was then referred for chemo-radiotherapy. A CT scan was done for treatment planning. The patient was positioned supine using a vacuum bag, headrest, and beam-directional shell for immobilization, ensuring precision during treatment. Whole-body images were obtained with 5mm slices from vault of the skull to the bottom of the sacrum, with 3mm slices throughout the primary tumour.
CLINICAL COURSE
3D-Conformal radiotherapy commenced one month post-surgery and included craniospinal irradiation using 2 parallel opposed cranial fields and one direct posterior field to the spine (23.4 Gy in 13 fractions) followed by a posterior fossa boost (30.6 Gy in 17 fractions), totalling 54 Gy. Treatment employed multi-leaf collimators and weekly field feathering to optimize dose distribution and minimize toxicity. Dexamethasone was used to cater for vasogenic oedema. The patient was able to complete treatment without severe late effects and with a single interruption. Reactions noted were erythema, vasogenic oedema and fatigue, these resolved post treatment and the patient since regained the ability to walk
DISCUSSION
The patient showed significant clinical improvement, including regaining ability to walk, indicating effective tumour control, neurological recovery and reduced treatment-toxicity. This case shows the importance of timely, precise radiotherapy and supportive care in achieving favourable outcomes in low-resource countries when treating paediatric brain tumours
AUTHOR: LAVERNE HAMADZIRIPI-SOBER rufarosober@gmail.com