Table 1 Time table
Relevant Past Medical History and Interventions | |||
The 21-year old man was diagnosed with GBM at 13 years of age. After tumor extirpation, he regularly underwent temozolomide chemotherapy and radiotherapy (66.6 Gy) from February 2007 to April 2007 and no brain GBM recurrence was shown at brain MRI during this round of treatment. However, progressing in cystic size was noted during regular clinics visit after previous treatment, radical resection of tumor was done in August 2007. Then he maintained with Temozolomide treatment for 8 more years (111 cycles). | |||
Date | Summaries from Initial and Follow-up Visits | Diagnostic Testing (including dates) | Interventions |
2015.8 | Chief complaint of an intermittent shadow in the vision when changing positions for several years. Initial diagnosis: optic nerve tumor, likely secondary to GBM. | BCVA:20/20 in both eyes. RAPD(+) and optic disc swelling (OD). VF: enlarged blind spot (OD). Orbital MRI: enhanced fusiform optic nerve tumor before the optic chiasma on a T1- weighted contrast image. | Aggressive chemotherapy (temozolomide 380 mg). |
2015.11 | Clinical course deteriorated 3 months after symptom onset. | BCVA :20/30(OD). VF: severely constricted with only central area preservation(OD). Orbital MRI: progressive changes in the right optic nerve lesion involving the chiasm on a T1- weighted image. | |
2015.12 | Clinical course severely deteriorated 4 months after symptom onset. Histopathology proved malignant optic glioblastoma. | BCVA:2/200. Histopathology from a right optic nerve biopsy: glioblastoma. | One month after the biopsy: CCRT with temozolomide (140 mg/day) and irradiation of the involved field (60 Gy, 30 times). Afterwards, a new regimen of chemotherapy was administered (Bevacizumab). |
2016.7 | Optic nerve tumor progressed 11 months after symptom onset. | Brain MRI: a right optic nerve tumor extending to the optic chiasm with progression in size. | Underwent right optic nerve tumor resection. |
2016.8 | The ability to have CCRT can preserve visual function in the fellow eye. | BCVA and VF were within the normal range in the left eye and no recurrence or metastasis was noted in the latest follow-up brain MRI. | |