Adaptive hypofractionated gamma knife radiosurgery for a large brainstem metastasis

Area of Science:

• Neurosurgery
• Radiation Oncology
• Oncology

Background:

• Brainstem metastases present a significant clinical challenge.
• Traditional treatments like radiotherapy and microsurgery may be contraindicated.
• Adaptive hypofractionated radiosurgery offers a novel approach.

Purpose of the Study:

• To demonstrate the efficacy of Gamma Knife (GK) radiosurgery for a large brainstem metastasis.
• To evaluate adaptive hypofractionation as a treatment modality for challenging brain lesions.

Main Methods:

• A patient with metastatic non-small cell lung cancer and a large brainstem lesion was treated with GK radiosurgery.
• The treatment involved three sessions of adaptive hypofractionated radiosurgery within one week.
• Magnetic resonance imaging (MRI) was used for monitoring tumor response and potential side effects.

Main Results:

• Initial treatment resulted in an 18% tumor volume reduction after the last session.
• Significant tumor volume reduction of 67% was observed 2.5 months post-treatment.
• The patient experienced manageable radiation-induced perilesional edema, with no tumor recurrence detected at 12-18 months.

Conclusions:

• Gamma Knife (GK)-based stereotactic adaptive hypofractionation is effective for tumor control in large brainstem metastases.
• This modality limits local adverse reactions, making it suitable for critical brain areas.
• GK radiosurgery should be considered for managing large brain lesions in challenging locations.