Brain Tumor Res Treat.  2022 Apr;10(2):129-133. 10.14791/btrt.2022.0009.

Combined Treatment With Radiotherapy and Immunotherapy for Isocitrate Dehydrogenase Mutant Brainstem Glioma in Adult: A Case Report

• Morimoto T
• Matsuda R
• Nakazawa T
• Nishimura F
• Nakagawa I

• KMID: 2529436
• DOI: http://doi.org/10.14791/btrt.2022.0009

Abstract

Brainstem gliomas are not common in adults, and the treatment strategies and their outcomes are limited. Immunotherapy is emerging as a promising new modality for the treatment of these gliomas. Here, we report the first case of brainstem glioma treated with a combination of radiotherapy and autologous formalin-fixed tumor vaccine (AFTV). A 32-year-old man presented with left facial numbness and right hemiparesis, and was referred to our department. MRI and open biopsy indicated brainstem glioma, and he was specifically diagnosed with isocitrate dehydrogenase 1-mutant diffuse astrocytoma of WHO grade II. He was treated with stereotactic radiotherapy followed by AFTV three months later. MRI conducted at 42 months after the combination therapy showed a 91% decrease in tumor volume, and the regression was maintained for 5 years. Thus, combination treatment with radiotherapy and immunotherapy may prove to be a promising alternative for the treatment of brainstem glioma.

Keyword

Glioma; Astrocytoma; Immunotherapy; Radiotherapy; Cancer vaccine

Figure

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  Fig. 1 Scans from MRI of the head conducted on admission. A-C: T2-weighted images showed hyperintense lesions in the pons, midbrain, and left middle cerebellar peduncle. D: Contrast-enhanced MRI demonstrated mild enhancement of the lesion.

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  Fig. 2 Histopathological and immunohistochemistry findings for the first open biopsy sample. A: Histopathological examination of the tumor with hematoxylin and eosin staining revealed an infiltrative, diffuse growth pattern of glioma cells. B and C: Immunohistochemistry staining for mutant IDH1 (B) and p53 (C) showed positive results. D: The Ki-67/MIB-1 index was 2%–3%. E: The staining results for H3K27M were negative.

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  Fig. 3 Clinical course and the corresponding MRI scans. Open biopsy was first performed, and based on the findings, SRT and one course AFTV were performed. Six months after open biopsy, MRI showed regression of the tumor. MRI conducted at 42 months demonstrated significant regression of the tumor. The radiographic response indicated clinical improvement. AFTV, autologous formalin-fixed tumor vaccine; SRT, stereotacic radiotherapy.

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  Fig. 4 Histopathological examination of the second open biopsy sample. Poor infiltration of immune cells was observed. The results of immunohistochemistry staining for CD3 (A), CD4 (B), and CD8 (C) were negative.

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