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CASE REPORT article

Front. Oncol.

Sec. Radiation Oncology

Volume 15 - 2025 | doi: 10.3389/fonc.2025.1620637

This article is part of the Research TopicInnovative Approaches in Precision Radiation OncologyView all 16 articles

Case Report: Multimodal Management of a Rare Pediatric Astroblastoma Using Proton Beam Therapy and Gamma Knife Radiosurgery-A Case Report and Literature Review

Provisionally accepted
Xijia  ZhangXijia Zhang1,2Xinfa  WangXinfa Wang3Weihai  NingWeihai Ning4Jianfeng  LiangJianfeng Liang5JIN  YONGLONGJIN YONGLONG6Yuqian  NieYuqian Nie7Jie  WangJie Wang8zishen  wangzishen wang8Wei  WangWei Wang8Jun  ZhaoJun Zhao8Jingjing  KongJingjing Kong8Lu  YangLu Yang8Dongxue  ZhouDongxue Zhou8Yue  ZouYue Zou8Masashi  MizumotoMasashi Mizumoto9Shosei  ShimizuShosei Shimizu8*
  • 1Beijing Tiantan Hospital of Capital Medical University, Beijing, China
  • 2beijing tiantan, Beijing, China
  • 3Children’s Hospital of Nanjing Medical University, Nanjing, China
  • 4Sanbo Brain Hospital of Capital Medical University, Beijing, China
  • 5Peking University International Hospital, Beijing, China
  • 6The Affiliated Hospital of Qingdao University, Qingdao, China
  • 7Hebei Yizhou Cancer Hospital, Baoding, China
  • 8Hebei Yizhou Cancer Hospital, Baoding City, Hebei Province,, China
  • 9University of Tsukuba, Tsukuba, Japan

The final, formatted version of the article will be published soon.

Introduction): Astroblastoma is an infrequent glial tumor, with the MN1-altered subtype recognized in the 2021 WHO classification. This report details the management of a 4-year-old girl diagnosed with CNS WHO Grade 3 MN1-altered astroblastoma, also found to have a heterozygous BRCA2 mutation. We highlight a sequential multimodal treatment approach involving proton beam therapy (PBT), targeted chemotherapy with a PARP inhibitor, and subsequent salvage Gamma Knife radiosurgery (GKRS).(Main symptoms and findings): The patient presented with right lower extremity weakness and gait disturbance. Initial treatment involved maximal safe resection followed by adjuvant PBT (craniospinal irradiation 36 Gy, local boost to 54 Gy). PBT was selected for its dosimetric advantages, notably minimizing radiation dose to surrounding healthy tissues, thereby reducing potential acute toxicity and long-term risks compared to conventional photon therapy. Despite this, residual tumor persisted. Following the discovery of a BRCA2 mutation, the PARP inhibitor fluzoparib was administered, which was associated with temporary disease stabilization.(Diagnoses, interventions, outcomes): After a second resection confirming residual disease, salvage stereotactic radiosurgery (SRS) using Gamma Knife (30 Gy in 5 fractions) was administered to the remaining lesions. The patient has demonstrated sustained local control with no tumor progression for over 18 months post-SRS, with only mild, asymptomatic perilesional edema and no neurological deficits.(Conclusion -Take-away lesson): This case suggests that leveraging the tissue-sparing benefits of initial PBT may enable effective salvage SRS for managing residual or recurrent high-grade pediatric astroblastoma. Furthermore, it highlights the potential role of molecular profiling to guide targeted therapies in these rare tumors.

Keywords: Astroblastoma, proton beam therapy, gamma knife radiosurgery, pediatric oncology, case report

Received: 29 Apr 2025; Accepted: 08 Aug 2025.

Copyright: © 2025 Zhang, Wang, Ning, Liang, YONGLONG, Nie, Wang, wang, Wang, Zhao, Kong, Yang, Zhou, Zou, Mizumoto and Shimizu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Shosei Shimizu, Hebei Yizhou Cancer Hospital, Baoding City, Hebei Province,, China

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