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Effect of proton radiotherapy on leptomeningeal metastases from pineal germinoma

(A) Sagittal T1-MRI with contrast demonstrating leptomingeal disease (arrows) from pineal region germinoma. (B) T2-weighted MRI 2 years after proton radiotherapy demonstrates fatty marrow changes ending in midvertebral body consistent with radiation dosimetry. (Contributed by Dr. Nadia Laack.)

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  • Pan-hypopituitarism
  • Precocious puberty
  • Radiation-induced nervous system injury