Durable tumor control with stereotactic radiotherapy and doxorubucin-ifosfamide chemotherapy in primary intracranial sarcoma, DICER1-mutant: a case report.

Abstract

Primary intracranial sarcoma, DICER1-mutant (PIS-DICER1), is an extremely rare and aggressive central nervous system tumor newly classified in the 2021 WHO classification of central nervous system tumors. It typically affects children and young adults and frequently recurs despite multimodal treatment, with no established standard therapy owing to limited clinical data. Herein, we report the case of a 28-year-old woman who developed a persistent headache and nausea shortly after giving birth. Imaging revealed a right cerebellar mass with obstructive hydrocephalus, for which gross total resection was performed. Histopathological and genomic analyses confirmed the diagnosis of PIS-DICER1. Six months later, the tumor recurred, necessitating a second resection. However, rapid regrowth was observed within two weeks. The patient subsequently underwent stereotactic radiotherapy (35 Gy in five fractions) targeting the recurrent lesion and surgical cavity, followed by six cycles of doxorubicin-ifosfamide chemotherapy. The combined approach achieved a complete response. Twelve months after treatment completion, a third surgery was performed for suspected recurrence; however, histopathological examination revealed radiation necrosis without a viable tumor. The patient remained in complete remission 40 months after the completion of chemoradiotherapy and 51 months after the initial surgery. This case demonstrates that stereotactic radiotherapy combined with doxorubicin-ifosfamide chemotherapy can achieve durable tumor control in PIS-DICER1, suggesting a potential therapeutic option for this highly aggressive tumor.