Long-Term Management of Brain Metastases From Small-Cell Lung Cancer: A Case Report of a Survivor Treated With...

There is a paucity of studies specifically addressing the treatment of brain metastases with many courses of stereotactic radiosurgery (SRS) over a long duration (i.e., years) of time. Given the morbidity of whole-brain radiotherapy (WBRT), describing the outcomes of patients treated in this manner is important. We report a case of a 48-year-old man who developed a single brain metastasis eight months after completing concurrent chemoradiotherapy for T2aN2M0, Stage IIIA small-cell lung cancer. Over the next ~13 months, each new brain magnetic resonance imaging (MRI) scan (at less than three-month intervals) revealed two to four new, asymptomatic brain metastases. Thereafter, new lesions appeared every two to three MRI scans for 17 months, after which no new lesions developed. Ultimately, he underwent nine separate SRS courses, treating a total of 21 brain metastases, over the course of two and a half years. He never developed extracranial disease progression and no brain metastases locally recurred after SRS. He developed no symptomatic adverse effects from any SRS treatment. He now remains free of disease, with his last SRS more than one year from his last follow-up imaging. This case highlights that in some patients, brain metastases can be considered a potentially chronic condition manageable with multiple courses of SRS over time, in an effort to delay or prevent the need for WBRT.