A 10-year-old boy who, in December 2000, after presenting clinical pain in the right lower limb, was diagnosed with bilateral neuroblastoma stage IV due to bone marrow involvement and pathological uptakes in the left hip and dorsal scintigraphy.
Once the SEOP NB-99 protocol was established, polychemotherapy treatment was initiated without response after the first reassessment, so a second line of chemotherapy with tumor persistence in the adrenal gland and in the right area was administered.
In September 2001 surgery of the adrenal mass was performed, confirmed by pathological anatomy neuroblastoma with post-chemotherapy changes, subsequently receiving adjuvant systemic treatment.
In November, the mass was resected; the histological report described ganglioneuroma.
The chemotherapy regimen continued with persistence but decreased tumor volume, so our service was regional to perform treatment.
At the beginning of 2002, we managed to irradiate a tumor volume with margins, by means of three-dimensional planning, with photons of 15 Mv and four fields until reaching a dose of 25.38 Gy.
In April 2002, an autologous transplant was performed, but seven months later, metastatic progression was confirmed and a second transplant was performed in July 2003.
The patient was admitted to the emergency room in November due to left parietotemporal headache refractory to medical treatment and accompanied during the last days by vomiting in a gun.
A cranial CT scan showed a 4 cm diameter hyperintense lesion in the left frontal lobe with significant perilesional edema and midline shift with herniation, compression of the left lateral ventricle and suspected accompanying bleeding.
They refer the patient after establishing supportive treatment and antiedema measures that were not effective.
Urgently, he began radiotherapy on a holocraneal volume, using telecobalttherapy and two lateral fields, with a 300 cGy consolidation/day until reaching a total dose of 21 Gy.
The response to treatment was good, with improvement in the level of consciousness four days after starting irradiation, with disappearance of nausea and vomiting and headache control.
