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Radiation isodose lines for pineal germinoma with leptomeningeal metastases

Radiation isodose lines for 20-year-old male treated with craniospinal proton radiotherapy and pineal region boost without chemotherapy for pineal germinoma with leptomeningeal metastases. (A) Isodose lines depicting dose of 23.4 Gy (pink) to the whole brain and boost to 45 Gy (white) to pineal disease. Isodose curves show steep falloff between 23.4 Gy CSI dose and 45 Gy primary tumor boost. (B) Sagittal CT of colorwash representation of radiation doses for craniospinal radiation. Target is covered by 23.4 Gy (red). Note steep dose fall-off in midvertebral body and lack of exit dose in abdomen with proton radiotherapy. (Contributed by Dr. Nadia Laack.)

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