Radiation therapy in a pediatric patient with Gorham Stout syndrome

www.appliedradiationoncology.com APPLIED RADIATION ONCOLOGY n 23 July 2014 CASE SUMMARY A 14 year-old female presented to the University of Arizona Cancer Center, Tucson, 8 years ago with a pathologic fracture in the right distal femur secondary to a diagnosis of Gorham Stout syndrome (GSS) established since infancy (Figure 1). She was successfully treated with radiation therapy (RT) and had a complete pain response. She returned to the clinic several months ago with severe pain in the right hip, requiring hospitalization. A magnetic resonance image (MRI) of the pelvis revealed cortical destruction of the anterior aspect of the proximal right femur at the intertrochanteric region secondary to lymphatic malformation consistent with GSS. She was treated with 3-dimensional conformal radiation therapy (3D-CRT) using 15 MV photons to the right femoral head to 3,000 cGy in 200 cGy fractions. The previous radiation fields were reviewed to avoid overlapping treatment fields. The patient had excellent pain response to treatment and continues to be pain free 6 months later without the need for pain medications. Furthermore, she remains pain free in the previously treated distal right femur 8 years after treatment.