From Progression to Stability for Recurrent Diffuse Astrocytoma with ECCT as sole treatment.

A 36-year-old male was diagnosed with right temporal diffuse astrocytoma WHO Grade 2 in 2020 following a seizure episode. He underwent his first craniotomy and tumour debulking that same month, with 70% of the tumour successfully removed. Histopathology confirmed an IDH-mutant, 1p/19q co-deleted tumour. The remaining tumour could not be safely excised due to its proximity to eloquent brain structures. Serial MRI over the following three years documented progressive enlargement of the residual disease.

In 2023, he has worsening seizures and prompted a second craniotomy and tumour debulking after Recurrent Diffuse Astrocytoma. A small portion of tumour was left adherent to the thalamus and midbrain. The surgery resulted in left-sided hemiparesis and left homonymous hemianopia. Through rehabilitation, he regained independent mobility within one month. Notably, seizures ceased entirely following this surgery, and his antiepileptic medication was subsequently discontinued. He has remained seizure-free without medication since.

From early 2025 to May 2025, he completed 30 cycles of radiotherapy combined with 12 cycles of Temozolomide chemotherapy. Despite completing the full standard-of-care regimen, serial MRI during this period showed increasing intralesional nodular enhancement with perfusion changes consistent with high-grade malignant transformation. The post-treatment MRI confirmed disease progression with new lesions. The oncology team proposed escalation to Avastin and Irinotecan as the next line of treatment. The patient however declined and opted for ECCT instead. No concurrent chemotherapy, radiotherapy, or steroids were administered throughout the ECCT period.

Blood tests conducted after 3rd month of ECCT showed all haematological, liver, and renal parameters within normal limits. Haemoglobin, platelets, and white cell count all reflecting well-preserved bone marrow function. Renal function was excellent. Total protein and albumin were stable across all timepoints. There was no biochemical evidence of treatment-related organ toxicity with ECCT.

The MRI conducted 3 months post ECCT was compared against the earlier progression MRI scan. The residual tumour at the right basal ganglia and thalamus showed no significant change in size. The previously documented small enhancing subcortical lesions at the right posterior parietal lobe had resolved. No new lesions were identified. The radiological conclusion was stable disease with lesion resolution at the posterior parietal region. A subsequent MRI in 2026 confirmed continued stability with no new growth.

Aside, the patient was alert, coherent, and communicating in full sentences. Physical function had improved from his post-surgical baseline, he was able to drive independently and had returned to his full-time employment. He remained on no medications other than Losartan for blood pressure management. His treating oncologist moved him to a 6-monthly MRI surveillance schedule.

In summary, this patient with recurrent Grade 3 astrocytoma, having progressed through two surgical debulkings and a full course of chemoradiotherapy, commenced ECCT as his sole active treatment following documented disease progression. His imaging demonstrated stabilisation of the primary lesion and resolution of satellite lesions, blood parameters remained consistently normal, and physical function and independence improved. More importantly, he got his life back and able to perform much more meaningful daily activities.

Names and identifying details have been covered to protect patient privacy. All medical data is drawn directly from verified clinical records and verifiable. This testimonial is for educational purposes only and does not constitute medical advice. Individual outcomes may vary.