Patient Presentation:

A 27-year-old male had seizures, dry heaves, described an unpleasant smell and experienced anxiety in November 2020. Imaging at that time demonstrated a large frontal lobe mass that was identified as a low-grade glioma which was surgically resected. The patient has been under follow-up since then. Recently, surveillance MRI scans showed evidence of tumor progression. The patient was then referred for consideration of radiation therapy in conjunction with chemotherapy.

Treatment:

Radiation therapy was recommended to optimize his local tumor control and prevent further disease progression. In light of his young age and tumor location, proton therapy was considered to be able to spare the surrounding normal structures including eyes, optic nerves, optic chiasm, brain stem and memory center (hippocampus) to avoid the detrimental effect of radiation on these organs and subsequent negative impact on his quality of life (Figure 1).

Outcome:

The patient received 6 weeks of proton therapy for a total of 30 fractions. He tolerated his treatment exceedingly well and returned to his medical oncology and neurology teams for continued care.

Figure 1 depicts treatment plan comparisons. The radiation dose distribution shows complete avoidance of the right side of the brain and right hippocampus with protons (LEFT) versus photons (RIGHT).