J Korean Neurosurg Soc.  2013 Dec;54(6):528-531. 10.3340/jkns.2013.54.6.528.

Successful Treatment of Infantile Fibrosarcoma Spinal Metastasis by Chemotherapy and Stereotactic Hypofractionated Radiotherapy

• Lo CH
• Cheng SN
• Lin KT
• Jen YM

• KMID: 2190953
• DOI: http://doi.org/10.3340/jkns.2013.54.6.528

Abstract

We report a case of infantile fibrosarcoma in an 8-month-old boy manifested as a right-sided lower leg mass. Repeated local recurrence and distant metastasis were noted during the following three-year period. Whole body fluoro-deoxyglucose positron emission tomography scan revealed an asymptomatic metastasis involving the fourth lumbar vertebrae. The patient received chemotherapy (VAC regimen) with Cyberknife(R) stereotactic hypofractionated radiotherapy (26 Gy; 4 fractions). This treatment reduced tumor size by 23% without acute radiation toxicity even after 33 months. This case suggests that combining chemotherapy and this form of radiotherapy may be safe and effective against childhood spinal metastasis.

Keyword

Cyberknife(R); Hypofractionated radiotherapy; Infantile fibrosarcoma; Spinal metastasis

MeSH Terms

Drug Therapy*
Fibrosarcoma*
Humans
Infant
Leg
Lumbar Vertebrae
Male
Neoplasm Metastasis*
Positron-Emission Tomography
Radiotherapy*
Recurrence

Figure

• 

  Fig. 1 Sagittal (A) and axial (B) views of T1-weighted MRI scans with gadolinium contrast enhancement reveals a contrast-enhancing nodule of 1.6 cm in the posterior aspect of the L4 vertebral body with local FDG uptake (C) at the posterior aspect of the vertebral column, which is consistent with tumor metastasis. FDG : fluoro-deoxyglucose.

• 

  Fig. 2 Axial (A), coronal (B) and sagittal (C) views of the isodose distribution with a 10% step gradient, and the dose volume histogram of the planning target volume (PTV) and spinal cord (D). A dose of 26 Gy was prescribed to the 75% isodose lines, divided into 4 fractions with the PTV coverage of 92.64%. The maximal spinal cord dose is 744.3 cGy, which is equal to a biologically effective dose (BED3) of 12.1 Gy.

• 

  Fig. 3 Sagittal unenhanced T1-weighted (A), sagittal and axial gadolinium-enhanced T1-weighted fat-suppressed (B and C) MRI scans shows the well-delineated boundary of the irradiated 4th lumbar vertebral column with fatty changes in the bone marrow, which is consistent with post-irradiation bone change. Note the shrinkage of the contrast-enhancing lesion with the reduction of tumor volume from 2.2 cm3 to 1.7 cm3, i.e., 23% after radiotherapy.

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