What happens when treatment for a rare aggressive brain tumor becomes too toxic for an older patient?

Details

Atypical teratoid/rhabdoid tumor (ATRT) is a rare, highly malignant central nervous system (CNS) tumor, most commonly diagnosed in children and only infrequently reported in older adults. Classified as a World Health Organization (WHO) grade IV tumor, it has a poor prognosis and typically requires aggressive treatment using multiple approaches. In elderly patients, management is particularly difficult because of coexisting illnesses, a lack of evidence-based guidelines, and a heightened risk of treatment-related toxicity.

This single-patient case report describes a 75-year-old woman with hypertension and hyperlipidemia who developed progressive dizziness, headache, and blurry vision. Imaging revealed a pituitary macroadenoma compressing the optic chiasm. After transsphenoidal hypophysectomy, histopathological examination unexpectedly confirmed ATRT, CNS WHO grade IV.

She began craniospinal radiation and systemic chemotherapy. Her treatment course was complicated by severe thrombocytopenia, critical illness myopathy, and persistent encephalopathy attributed to prolonged steroid use and metabolic derangements. Follow-up imaging showed stable disease with reduced mass effect on the optic chiasm. Because she tolerated treatment poorly, radiation was discontinued after 26 sessions, and she was discharged to rehabilitation with plans to continue chemotherapy. Her condition subsequently deteriorated further because of treatment-related complications, and she ultimately died under hospice care.

The case highlights the diagnostic and treatment challenges of ATRT in older adults, for whom standard pediatric-based regimens may be excessively toxic. It points to the need for individualized, patient-centered treatment strategies that prioritize disease control, treatment tolerance, functional status, and quality of life.