case_images: PMC3794517_01
case_images: MRI scan obtained after this patient initially presented to the emergency department demonstrating 4.5 cm, ring-enhancing, left parietal mass with surrounding edema consistent with GBM.
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case_images: PMC3794517_01_CRIM.ONCMED2013-431857.001.jpg
case_images: fig1
case_images: His initial MRI scan revealed a single, 4.5 cm, ring-enhancing, left parietal mass with surrounding edema which was consistent with glioblastoma multiforme (GBM) (see Figure 1).
case_images: Four months after initial diagnosis, the patient suffered a recurrence of GBM and was treated with GKRS. The prescribed dose was 16 Gy to the 50% isodose line. Tumor volume was measured at 5.2 cubic centimeters.
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case_images: fig2
case_images: The marginal prescription dose was 16 Gy to the 50% isodose line. 99% of the tumor, at 5.2 cubic centimeters, received at least 16 Gy (see Figure 2).
case_images: MRI scan showing increased enhancement, indicating tumor recurrence twenty-two months after GKRS salvage treatment.
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case_images: fig3
case_images: MRI scans at 17 and 20 months after GKRS treatment revealed a new 2 cm diameter nodule deep to the resection bed with an area of enhancement in the cystic area superficial to that (see Figure 3).
case_images: Treatment planning for second salvage GKRS treatment after the second recurrence of GBM. Again, 16 Gy was prescribed to the 50% isodose line.
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case_images: fig4
case_images: Once again, the prescription dose was 16 Gy to the 50% isodose line and was well tolerated by the patient (see Figure 4).
case_images: Treatment planning for one of the three fractions of 7 Gy each to the 50% isodose line (21 Gy total). This was his third and latest salvage GKRS which was administered 46 months after initial diagnosis.
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case_images: PMC3794517_01_CRIM.ONCMED2013-431857.005.jpg
case_images: fig5
case_images: He received 3 separate fractions over an 8-day-period with a prescription of 7 Gy per fraction which was well tolerated (21 Gy total dose prescribed to the 50% isodose line, Figure 5).