Intraoperative Placement of an Absorbable Spacer Prior to Radiation Therapy for a Malignant Peripheral Nerve Sheath Tumor

Yuki Endo; Taichi Fukuzawa; Masahiro Irie; Hideyuki Sasaki; Hironori Kudo; Ryo Ando; Ryuji Okubo; Saori Katayama; Masatoshi Hashimoto; Kosuke Sato; Masahito Tachibana; Hidekazu Aoki; Masayuki Araya; Koichi Hirabayashi; Shoji Saito; Hidekazu Masaki; Yozo Nakazawa; Yoji Sasahara; Motoshi Wada

doi:10.1159/000524824

Intraoperative Placement of an Absorbable Spacer Prior to Radiation Therapy for a Malignant Peripheral Nerve Sheath Tumor

Case Rep Oncol. 2022 May 20;15(2):541-546. doi: 10.1159/000524824. eCollection 2022 May-Aug.

Authors

Yuki Endo¹, Taichi Fukuzawa¹, Masahiro Irie², Hideyuki Sasaki¹, Hironori Kudo¹, Ryo Ando¹, Ryuji Okubo¹, Saori Katayama², Masatoshi Hashimoto¹, Kosuke Sato¹, Masahito Tachibana³, Hidekazu Aoki⁴, Masayuki Araya⁵, Koichi Hirabayashi⁶, Shoji Saito⁶, Hidekazu Masaki⁵, Yozo Nakazawa⁶, Yoji Sasahara², Motoshi Wada¹

Affiliations

¹ Department of Pediatric Surgery, Tohoku University Graduate School of Medicine, Sendai-shi, Japan.
² Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai-shi, Japan.
³ Department of Gynecology and Obstetrics, Tohoku University Graduate School of Medicine, Sendai-shi, Japan.
⁴ Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai-shi, Japan.
⁵ Proton Therapy Center, Aizawa Hospital, Nagano, Japan.
⁶ Department of Pediatrics, Shinshu University School of Medicine, Nagano, Japan.

Abstract

A 7-year-6-month-old female was diagnosed with a pelvic malignant peripheral nerve sheath tumor and lymph node metastases. Tumorectomy was performed after four cycles of chemotherapy. A 33-mm cystic lesion was observed around the left iliac muscle after three cycles of postoperative chemotherapy, and proton beam therapy (PBT) was recommended. She was referred for absorbable spacer (AS) placement. The left ovarian appendage (OA) was resected due to the direct tumor infiltration. The right OA was fixed to the uterosacral ligament. The AS was fixed to the lateral pelvis. The PBT (70.3 Gy relative biological effectiveness) was performed successfully with the AS, and she also had the reproducing possibility due to prevention of severe irradiation damage of the right OA. AS eliminated the surgical removal of spacers and enabled us high-dose PBT for residual tumor without severe irradiation damage including infertility.

Keywords: Absorbable spacer; Malignant peripheral nerve sheath tumor; Proton beam therapy; Radiation therapy.

Publication types

Case Reports