Diagnosis
Anaplastic ependymoma of the brain in the region of the fourth ventricle, WHO Grade II. The tumor encases the vertebral artery. The patient is in status following surgical treatment (ventriculoperitoneal shunting and partial tumor resection), postoperative chemotherapy, and radiation therapy. There is ongoing growth of the residual tumor.
Patient:
Child, 3 years old, Uzbekistan
Physician:
Prof. Martin Scholz, Chief Physician at the Department of Neurosurgery, Hospital Duisburg
Patient's complaints:
Intermittent gait disturbance and dizziness.
Response from neurosurgeon professor Martin Scholz:
The patient's medical history and the continued growth of the residual mass indicate the need for repeat surgery. We will attempt to remove the tumor around the vertebral artery. The prognosis for recovery from ependymomas of the brain is favorable if the tumor can be completely removed.
Chemotherapy will likely be required again after surgery.
Estimated cost of surgery: €42,000
Treatment performed:
A midline occipital craniotomy was performed for tumor removal with neurophysiological monitoring. Follow-up MRI scans after the operation revealed no residual tumor.
The child was discharged from the clinic in good condition ten days after the surgery.
The actual cost of the surgery: €35,730
Further treatment plan:
Based on the results of the histological analysis of the removed tumor tissue, the family was referred for a consultation with Professor Marc Remke, Chief Physician of the Department of Pediatric Neuro-Oncology at Saarland University Hospital, to coordinate the further treatment plan.
Professor Remke responded that he had reviewed the child’s medical history and the treatment recommendations from Professor Fleischhack, Chief Physician of the Department of Pediatric Oncology at the University Hospital Essen.
We currently recommend temozolomide at a dose of 150–200 mg/m² of body surface area for five days, followed by a 28-day break. The initial treatment duration is one year.
We do not know whether the child will be able to take the tablets orally. If not, we will prepare an oral suspension and administer the medication via a feeding tube.
Our recommendation to use temozolomide balances the potential benefits of this therapy against its side effects, compared to other treatment options. If there were convincing data showing that intensive chemotherapy would be significantly more effective, we would consider it.
Temozolomide is relatively easy to monitor, and this method often ensures a good quality of life with limited side effects. Maintaining a good quality of life during therapy is very important.
Unfortunately, radiation therapy, including proton therapy, is not possible based on the recommendations of radiation oncologists. Re-irradiation is a reasonable approach in the event of ependymoma recurrence and is used as an effective local therapy when complete resection aimed at achieving long-term tumor control is not possible. However, achieving the maximum effect of radiation therapy requires the use of a sufficiently high dose (>50 Gy).
In this case, both the primary and recurrent tumors were located in an anatomical region of the brain (the medulla oblongata up to the level of the first cervical vertebra, C1) where an adequate radiation dose cannot be administered due to the high risk of neurological complications, particularly paraplegia.
Colleagues from the radiation therapy center reported that only palliative radiation therapy would be possible at this point. However, this would not help the child in the long term.
The tumor cells sent to the lab for culture continue to grow, and we may receive the results of this study in the near future. Then, if necessary, we could adjust our treatment recommendations.
Review from the child’s Mother:
Hello, my name is Barno, and I’m from Uzbekistan. I have a three-year-old daughter. Last year, we received the frightening diagnosis of a brain tumor, so we traveled to Moscow for our first surgery. Unfortunately, they were unable to remove the tumor completely. Then, my husband found GHP Pulse and Konstantin’s contact information online. He spoke with Konstantin, who quickly arranged a visit for us to the SANA Duisburg clinic in Germany.
We arrived a few days ago and had the surgery. Professor Dr. Martin Scholz performed the surgery, which was successful. He removed the entire tumor, and we are very happy and grateful to him. We would also like to thank GHP Pulse and Konstantin. Thank you all for your help.
We are very grateful to you all.
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The treatment examples posted on this website are not medical recommendations and are for informational purposes only. Medications should only be used as prescribed by a doctor.