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A 7-year-old girl. In June 2024, after falling off her bicycle, she gradually developed headaches, unsteady walking, lethargy, and slow responses. Her family took her for medical evaluation, and a "large mass" was found in the brainstem region. Upon admission, MRI was completed, showing an intracranial tumor approximately 4.5 × 4.6 cm. Imaging findings were consistent with diffuse brainstem glioma and associated hydrocephalus. In addition, the child had concurrent pulmonary and intracranial infections, with worsening condition, unable to make large movements, and vomiting with any movement of the head.
The family recalls that after the incident, the child had been taken to another hospital. "At first, they said surgery was possible, but we considered that the child was too young, and also because of the tumor's location, the risk of surgical failure was very high, so we decided not to proceed with surgery at that time. Later, the hospital informed us that the tumor's position had worsened, making surgery impossible. So we came here immediately." Upon arrival at our hospital, the family reported that the child "was no longer fully alert and her responsiveness had declined slightly compared to the last time my husband came for consultation."
Before deciding on a treatment plan, the medical team conducted a comprehensive evaluation of the child. The chief physician explained: "After multiple imaging examinations, a primary tumor in the brainstem was identified, which is what we commonly refer to as diffuse brainstem glioma. Due to the high risk, no biopsy was performed." Considering the tumor's special location and its proximity to critical structures, the team decided, after a thorough assessment, to use radiotherapy as the main treatment and developed a low-dose fractionated radiotherapy regimen: 1.8 Gy per session for a total of 30 sessions, using the Varian TrueBeam radiotherapy system. Because of the child's severe condition, the relevant procedures were expedited. The family specifically mentioned: "After arriving here, Dr. Zhang was very good, cooperating with us; all procedures were expedited, and our child received treatment the next day."
After arriving here, Dr. Zhang was very good, cooperating with us;
During implementation of the treatment plan, radiotherapy was carried out according to the established protocol. Relying on the image-guided and high-precision irradiation capabilities of the TrueBeam radiotherapy system, irradiation of the lesion was performed based on immobilization, accurate positioning, and treatment planning. Throughout the course of treatment, the child's condition was continuously monitored, with concurrent infection control, supportive therapy, and nursing care provided as part of comprehensive management to ensure the smooth completion of the treatment course.
In terms of clinical symptoms, one week after initiation of treatment, the child regained some responsiveness, with a reduction in the duration of somnolence. By the midpoint of therapy, symptoms such as headache and gait instability were markedly alleviated, and weakness of the right limbs also improved. The child gradually recovered from the previous state of discomfort, with a significant improvement in quality of life.
After completion of radiotherapy, the child underwent repeat cranial MRI, including non-contrast and contrast-enhanced sequences. The results showed a marked reduction in tumor volume, decreasing from 4.5 × 4.6 cm before radiotherapy to 2.6 × 2.0 cm, representing a substantial reduction. At the same time, the surrounding edema was reduced, and compression of adjacent structures by the tumor was alleviated.
The family recalls that changes appeared gradually after the start of radiotherapy: "When radiotherapy had been going on for just about a week, she had already regained some responsiveness. She was no longer sleeping for such long periods, unlike before when she would sleep for more than twenty hours a day. After that, there were positive changes every week." She particularly remembered: "Dr. Zhang said that the effects would become more apparent around the 18th to 20th radiotherapy sessions. When my daughter reached 18--20 sessions, the changes were really obvious --- she was completely different. When we talked to her, she gave clear responses; she could cry and laugh..." She also mentioned changes in limb strength: "Previously, she could not move the right side of her body at all. Now the right side, especially the right leg, has gained strength, and she can already touch me with her foot."
Director Zhang added that upon admission, the child had marked vomiting, was unable to speak, and had flaccid paralysis of the limbs. After 1--2 weeks, limb movement began to improve; after 3--4 weeks, vomiting was reduced; after 5--6 weeks, the child was able to drink and eat, with clearer responsiveness. Treatment records show that after 5 radiotherapy sessions, the child could open her eyes spontaneously; after 12 sessions, the lower limbs could flex and extend voluntarily; after 22 sessions, she could drink and eat independently; and after 27 sessions, she could move independently in bed. Following comprehensive treatment, the child's symptoms improved significantly, and she was able to watch cartoons normally and communicate normally with others.
During hospitalization, the family also spoke about the environment and convenience: "Considering that our child is so young and coughs frequently, we hoped to have a single room. Fortunately, a single room was available. We all felt it was quite good --- the environment was acceptable, and the facilities here were fairly complete." For the family, beyond the treatment itself, what mattered even more was "whether the treatment could be carried through smoothly." From examinations and assessments, expedited completion of procedures, initiation of radiotherapy the next day, to supportive treatment, nursing care, and rehabilitation during the course --- every step was followed up and effectively implemented, giving the family a sense of reassurance during their most anxious period.
To families going through similar difficulties: treatment of brainstem glioma is often a process that requires patience and close cooperation. Seeking early evaluation at a specialized center, formulating a scientifically sound and individualized treatment plan, adhering to the treatment course, and attending scheduled follow-up examinations are crucial. Many changes emerge gradually as treatment progresses. Do not be deterred by terms such as "high risk" or "special location." Entrust decisions to professional assessment, and place hope in standardized treatment and every follow-up evaluation.
