Targeted Radionuclide Therapy in Diffuse Intrinsic Brainstem Gliomas: Exploring Options Beyond the Finish Line

Of the pediatric brainstem gliomas, around 80% develop in the pons, with the vast majority of pontine tumors being diffuse intrinsic brainstem gliomas (DIPG), which tend to be high grade, locally infiltrative, and have a poor prognosis. We present a 12-year-old girl diagnosed with DIPG in July 2022, who received 60 Gy, 30 fractions of radical radiotherapy over 6 weeks, followed by temozolomide. With residual disease, the patient was referred to our department for the possibility of radiotheranostics. She underwent 68 Ga PSMA PET/CT, which revealed tracer accumulation in the pontine mass and was subsequently given 2 cycles of Lu-177 PSMA 617 and 1 cycle of Ac-225 PSMA 617 therapy.