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Workshop:ASTRO E-contouring for CNS webinarFaculty:Dr. Elham Rahimy, MDCase Description:64yo M, KPS 60, GBM (IDH WT) of the left temporal lobe with asymptomatic transient leptomeningeal (LM) enhancement, MGMT negative. • Presented with symptomatic hydrocephalus (acute AMS, vomiting), found to have hemorrhagic tumor and leptomeningeal enhancement of the posterior fossa and upper C-spine.• Underwent VP shunt with improvement of hydrocephalus symptoms, and biopsy alone of the tumor. • LM enhancement resolved on interim MRI 5 weeks later (LM enhancement felt to be secondary to tumor hemorrhage). • After multidisciplinary evaluation and discussion, planned for hypofractionated radiotherapy with concurrent/adjuvant temodar.• Images fused: Initial MRI (T1+C and T2; MR secondary 1 and 2) showing the extensive LM enhancement in the posterior fossa, and ~5 week follow up MRI day before simulation with resolution of LM enhancement (T1+C and T2; MR secondary 3 and 4). He was claustrophobic with some motion degradation on scans despite Ativan. Homework:• GTV on Slices 58, 59, 60, 61• CTV on Slices 58, 59, 60, 61• PTV on Slices 58, 59, 60, 61• BrainStem on Slices 58, 59, 60, 61• OpticChiasm on Slices 58, 59, 60, 61• Cochlea_L on Slices 73, 74, 75Disabled Contours: All contours disabledEnabled Contours: NoneResource Files: - Vignette- EduCase Training Video: How to contour, complete the homework, and save/submit - EduCase User Guide
