P03.04.B Garcin syndrome and hippocampal-sparing WBRT: successful resolution of a rare case

Abstract Background first case of a rare Garcin syndrome resolution in young metastatic breast cancer(BC) patient treated with hippocampal-sparing approach. Material and Methods we report 49-year-old caucasian female. The medical record review was relevant for BC diagnoses 1997, when she 26yo; complicated by bone liver metastasis appeared 2008. In March 2020, referred to our department complaining about increasingly worsening left otalgia initial hearing loss, facial numbness, homolateral decreased sensitivity, increased lacrimation, tingling tongue. Clinical presentation suggestive Guillain-Alajouanine-Garcin Syndrome (Garcin Syndrome), caused lytic lesion the sphenoid wing. A contrast MRI (02/04/2020) brain demonstrated lesions wing, that noted infiltrate surrounding sinus wall, including clivus, pterygoid process petrous bone; two parietal occipital were identified partial leptomeningeal involvement. According good PS, underwent WBRT VMAT plus sequential boost on lesion. PTV OARs delineated according fused planning MRI/CT image. Bilateral hippocampal contours generated set RTOG 0933 contouring atlas. After that, avoidance(HA) region created expanding 5 mm all directions Brown et al.The PTV-HA defined as WB parenchyma, meninges skull, excluding HA-region, dose prescription 30Gy/10fx; PTV-Boost sphenoidal metastases, 12Gy/4fx. used deliver conformal RT plan. Planning priorities should be followed were:Hippocampus, OpticChiasm, OpticNerve_L or OpticNerve_R, Lens_L Lens_R. Results neurological symptoms improved after end complete months later. At last MRI, year half from RT, there no evidence lesion, referred. These are results plan sum: D2%=43.43 Gy, D98%=26.36 V30=94.96%; Hippocampus D100%=8.78 Dmax=17.24 Gy; Left OpticNerve Dmax=33.51%; Right Dmax=29.25%; OpticChiasm Dmax=35.93%. Conclusion To knowledge, this is described using technique spare hippocampus Syndrome. Prevention neurocognitive sequelae avoidance has shown promise several studies case. Sequential feasible effective.Advanced techniques may customize treatment allows preserving cognitive impairment achieving clinical long-term survival patients.