Journal of Evolution of Medical and Dental Sciences

Factors Affecting the Tumor Volume Reduction Rate During Adjuvant Radiation Therapy (RT) in Patients with Glioblastoma Multiforme (GBM)

2026-07-31T06:05:22+00:00

BACKGROUND

Glioblastoma multiforme is the commonest primary brain tumor in adults, responsible for 45.2% of primary brain tumors. It is considered a highly aggressive brain tumor with a grave prognosis. Standard treatment for GBM (Glioblastoma Multiforme) consists of maximal safe resection, adjuvant RT (Radiation Therapy), and temozolomide chemotherapy. Despite all the treatments, survival for GBM remains 15-18 months post-diagnosis. Several studies have demonstrated the prognostic significance of different factors, including age, performance status, extent of surgery, and status of molecular markers such as tumor MGMT promoter methylation and IDH mutation. Among the various factors, studies have shown that delaying the start of radiation therapy decreases survival in these patients.

METHODS

This retrospective study was conducted from January 2020 to June 2024 on 47 patients diagnosed with GBM. All these patients underwent surgical resection followed by adjuvant chemoradiation therapy and 6 cycles of maintenance temozolomide. Patient demographics, tumor, and treatment-related details were extracted from retrospectively collected, prospectively curated data. The patients who had been previously treated for a primary brain tumor or for whom pre-RT and follow-up scans were not available were excluded.

RESULTS

The median age at presentation was 45 years. The extent of surgical resection was subtotal in 91.5% of patients. Following surgery, tumor size greater than 4 cm was noted in 63.8% of the patients. The course of adjuvant and maintenance chemoradiation therapy could be completed by 86% of the patients. Among the factors influencing the tumor volume reduction during adjuvant RT, a delay in initiating RT beyond 3 weeks and a residual tumor greater than 4 cm were significantly associated with reduced mean percentage volume change.

CONCLUSIONS

This study provides an important insight into the various prognostic factors affecting the tumor volume reduction rate in GBM patients. We found that greater residual tumor volume following surgery and prolonged interval to RT significantly negatively influenced the rate of tumor volume reduction in GBM patients. Our study strengthens the fact that adjuvant RT should be started as early as possible after surgery. Future studies are warranted to elucidate the impact of the extent of surgical resection and the interval before initiating RT on patient survival.

Primary Central Nervous System Lymphoma Masquerading as Multiple Sclerosis - A Case Report

2026-07-31T06:05:20+00:00

Primary central nervous system lymphoma represents a rare and aggressive variant of non-Hodgkin lymphoma that remains confined to the central nervous system without systemic involvement at the time of diagnosis.^[1] We present a case of a 48-year-old immunocompetent male who initially received a diagnosis of multiple sclerosis but was subsequently found to harbor PCNSL (Primary Central Nervous System Lymphoma) of the diffuse large B-cell type.^[2] This case highlights the considerable clinical and radiological similarities between PCNSL and demyelinating disorders, demonstrating the critical importance of obtaining tissue diagnosis through biopsy and comprehensive immunohistochemical evaluation for accurate diagnosis and timely therapeutic intervention.^[1]

Primary central nervous system lymphoma accounts for approximately 3.3% of all primary brain tumors. In immunocompetent patients, the vast majority of PCNSL cases originate from germinal center B-cells and develop within the brain parenchyma, spinal cord, cerebrospinal fluid compartment, or intraocular structures without evidence of systemic disease. The diagnosis of PCNSL poses significant challenges due to its non-specific clinical presentation, ambiguous neuroimaging characteristics, and often unrevealing cerebrospinal fluid findings, leading to frequent misdiagnosis. Through this case presentation, we aim to emphasize the importance of including PCNSL in the differential diagnosis when magnetic resonance imaging demonstrates non-enhancing, diffusely infiltrative lesions.^[1]

Psammomatoid Ossifying Fibroma/Juvenile Psammomatoid Ossifying Fibroma

2026-07-31T06:05:19+00:00

Juvenile psammomatoid ossifying fibroma is a rare benign fibro-osseous neoplasm with locally aggressive behaviour and a high propensity for recurrence. We report a case of a 13-year-old female who presented with a painless right cheek swelling of 15 days' duration. Computed tomography revealed an expansile lesion involving the anterior wall of the right maxillary sinus with a ground-glass matrix, initially suggesting fibrous dysplasia. Histopathological examination demonstrated a cellular fibrous stroma containing numerous psammoma-like ossicles and irregular bony trabeculae with osteoblastic rimming, consistent with JPOF. Complete surgical excision was performed. JPOF may mimic other fibro-osseous lesions clinically and radiologically; therefore, histopathological evaluation remains essential for definitive diagnosis. Early recognition and complete excision are crucial because of the lesion's aggressive local growth and risk of recurrence. This case highlights the importance of considering JPOF in the differential diagnosis of expansile craniofacial lesions in pediatric patients.

JPOF (Juvenile Psammomatoid Ossifying Fibroma) is a rare benign fibro-osseous neoplasm characterised by aggressive local growth and a high tendency for recurrence despite its non-malignant nature. It is recognised as a distinct clinicopathological entity in the recent

WHO classification of head and neck tumours and predominantly affects children and young adults, with a predilection for the craniofacial bones, particularly the paranasal sinuses, orbit, and maxilla.^[1,2] Clinically and radiologically, JPOF may mimic other fibro-osseous lesions such as fibrous dysplasia, making histopathological examination essential for definitive diagnosis. We report a case of JPOF involving the right maxillary sinus in a 13-year-old female, highlighting its clinicopathological features and diagnostic challenges.