Abstract
RATIONALE: Extracranial metastases of primary brain tumors are rare, and there is no effective treatment. Here, we report a patient with anaplastic oligodendroglioma (AO, WHO grade III) who effectively delayed survival time after receiving temozolomide (TMZ), immunotherapy, and radiotherapy. PATIENT CONCERNS: A 42-year-old man underwent surgery and chemoradiotherapy for AO, 41 months ago. DIAGNOSIS: The patient developed lower back pain, and Positron emission tomography/computed tomography (PET/CT) did not detect any lesions other than the skeleton. Sacral aspirate smear showed atypic cell nests, and immunohistochemistry and fluorescence in situ hybridization testing supported the diagnosis of WHO grade III AO and IDH mutations. INTERVENTIONS: The patient was treated with TMZ, immunotherapy, and local palliative radiotherapy and was stable for 6 months, but the medication was discontinued due to severe myelosuppression. OUTCOMES: After drug withdrawal, the disease progressed further, with intracranial recurrence and metastasis to the liver, supraclavicular and axillary lymph nodes. The time from the diagnosis of extracranial metastasis to death was 10 months. LESSONS: This case show that immunotherapy, oral low-dose TMZ and local palliative radiotherapy may be effective ways to prolong the survival of patients with extracranial metastasis and severe bone marrow suppression.