Fractionated Gyroscopic Radiosurgery for Optic Nerve Glioma: A Case Report and Review of the Literature

TL;DR

A 20-year-old patient with optic nerve glioma was successfully treated with a new type of radiotherapy called gyroscopic radiosurgery, showing promising results with minimal side effects.

Contribution

This is the first reported use of gyroscopic radiosurgery for treating optic nerve glioma.

Findings

The treatment plan spared normal structures, potentially leading to better long-term outcomes.

The patient showed good clinical control with no significant toxicity after one month.

GRS may be considered as a first-line treatment option after further evaluation.

Abstract

Radiotherapy offers a favorable long-term outcome for the treatment of optic pathway glioma, but at a cost of neurocognitive impairment and decreased quality of life. This has led to a chemotherapy-first approach, deferring radiotherapy till disease progression. We present a case report wherein a 20-year-old female patient with left optic nerve glioma was treated with definitive radiotherapy using a self-shielding gyroscopic radiosurgery (GRS) system. We report the first published use of GRS in the treatment of optic nerve glioma.

The patient was treated with 15 Gy at the 56% isodose line in two fractions on alternate days with 17 isocenters and 271 non-coplanar beams, amounting to a total treatment time of 63 minutes. The evaluation of the treatment plan shows considerable sparing of the normal structures, which may translate into better long-term clinical outcomes. A clinical follow-up after a month of treatment showed good clinical control without any undue treatment-related toxicity. Further follow-up is slated as per standard protocol. This case report opens up the potential for considering GRS after careful scrutiny as a first-line approach in the treatment of optic nerve glioma.

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