case_images: PMC11342437_01
case_images: Axial T1 MRI showing the right cerebellar lesion.
case_images: 10.1177_2050313X241274218-fig1.jpg
case_images: PMC11342437_01_10.1177_2050313X241274218-fig1.jpg
case_images: fig1-2050313X241274218
case_images: The lesion, which had been stable for almost 15 years, measured 9.5 x 8.7 x 6.0 mm, and on the recent brain MRI (Three Tesla Phillips MRI) using a T1-TSE sequence, the lesion had increased in size and measured 16.0 x 16.3 x 15.9 mm (Figure 1).
case_images: Sagital view of proton radiation plan. Gross tumor volume (GTV) is in red, clinical target volume (CTV) is in orange, Brainstem is light blue, 95% isodose line is in light green, 50% isodose line is light purple, 25% isodose line is dark green and 5% isodose line is in blue.
case_images: 10.1177_2050313X241274218-fig2.jpg
case_images: PMC11342437_01_10.1177_2050313X241274218-fig2.jpg
case_images: fig2-2050313X241274218
case_images: He underwent re-irradiation with proton radiation to the brain lesion to a total dose of 54 Gray equivalents (GyE) in 1.8 GyE per fraction in 30 fractions (Figures 2 and 3).
case_images: Axial view of proton radiation therapy plan. The brainstem is light blue, the CTV is in orange and is almost completely covered by the 100% (yellow) and completely covered by the 95% (green) isodose line.
case_images: 10.1177_2050313X241274218-fig3.jpg
case_images: PMC11342437_01_10.1177_2050313X241274218-fig3.jpg
case_images: fig3-2050313X241274218
case_images: He underwent re-irradiation with proton radiation to the brain lesion to a total dose of 54 Gray equivalents (GyE) in 1.8 GyE per fraction in 30 fractions (Figures 2 and 3).
case_images: PMC11342437_02
case_images: Dose-volume histogram for proton therapy treatment. Red is the GTV, dark orange is the CTV, light blue is the brainstem, and yellow is the optic chiasm. The green and light orange lines in the low-dose area represent the optic nerves.
case_images: 10.1177_2050313X241274218-fig4.jpg
case_images: PMC11342437_02_10.1177_2050313X241274218-fig4.jpg
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case_images: A dose-volume histogram is shown (Figure 4) for the proton therapy.
case_images: Axial T1 MRI showing a complete radiographic response to treatment.
case_images: 10.1177_2050313X241274218-fig5.jpg
case_images: PMC11342437_02_10.1177_2050313X241274218-fig5.jpg
case_images: fig5-2050313X241274218
case_images: An MRI obtained 1 month after the completion of proton radiotherapy and chemotherapy and 3 days before maintenance chemotherapy demonstrated a substantial improvement in the cerebellar mass, with no disease noted on imaging (Figure 5).