Postoperative management of patients with brain metastases is controversial. Besides local control, cognitive function and quality of life are the most important outcomes of postoperative radiotherapy. In this case report, we introduce a patient with aggressive recurred solid metastasis treated with repeated surgery and an individual radiotherapy approach in order to highlight that close mutual collaboration leads to a clear benefit for our patients. The local targeted radiotherapy with 35 Gy in 10 fractions was performed with the volumetric modulated arc technique, leading to more than 2.5 years of local control and survival without any of the side effects usually attributed to whole brain radiotherapy.

Department of Neurosurgery University Hospital Brno and Faculty of Medicine Masaryk University Brno Czechia

Department of Radiation Oncology Faculty of Medicine Masaryk University Brno Czechia

Department of Radiation Oncology Masaryk Memorial Cancer Institute Brno Czechia

Department of Radiology Masaryk Memorial Cancer Institute Brno Czechia

Faculty of Medicine Masaryk University Brno Czechia

Zobrazit více v PubMed

Achrol AS, Rennert RC, Anders C, Soffietti R, Ahluwalia MS, Nayak L, et al. Brain metastases. Nat Rev Dis Primers. 2019;5((1)):5. PubMed

Kazda T, Kuklova A, Pospisil P, Burkoň P, Slavík M, Hynková L, et al. Utilization of prognostic indexes for patients with brain metastases in daily radiotherapy routine − is the complexity and intricacy still an issue? Klin Onkol. 2015;28((5)):352–8. PubMed

Chukwueke UN, Brastianos PK. Precision medical approaches to the diagnoses and management of brain metastases. Curr Treat Options Oncol. 2019;6;20((6)):49. PubMed

Tawbi HA, Forsyth PA, Algazi A, Hamid O, Hodi FS, Moschos SJ, et al. Combined nivolumab and ipilimumab in melanoma metastatic to the brain. N Engl J Med. 2018;379((8)):722–30. PubMed PMC

Nahed BV, Alvarez-Breckenridge C, Brastianos PK, Shih H, Sloan A, Ammirati M, et al. Congress of Neurological Surgeons systematic review and evidence-based guidelines on the role of surgery in the management of adults with metastatic brain tumors. Neurosurgery. 2019;84((3)):E152–E155. PubMed

Kazda T, Jancalek R, Pospisil P, Sevela O, Prochazka T, Vrzal M, et al. Why and how to spare the hippocampus during brain radiotherapy: the developing role of hippocampal avoidance in cranial radiotherapy. Radiat Oncol. 2014;9:139. PubMed PMC

Lakomy R, Hynkova L, Pospisil P, Burkon P, Slavik M, Slampa P, et al. Patterns of failure after brain metastases radiotherapy: reflections on the importance for treatment and clinical trials reporting. Neoplasma. 2017;64((3)):329–37. PubMed

Brown PD, Ballman KV, Cerhan JH, Anderson SK, Carrero XW, Whitton AC, et al. Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (NCCTG N107C/CEC·3): a multicentre, randomised, controlled, phase 3 trial. Lancet Oncol. 2017;18((8)):1049–60. PubMed PMC

Mahajan A, Ahmed S, McAleer MF, Weinberg JS, Li J, Brown P, et al. Post-operative stereotactic radiosurgery versus observation for completely resected brain metastases: a single-centre, randomised, controlled, phase 3 trial. Lancet Oncol. 2017;18((8)):1040–8. PubMed PMC

Traylor JI, Habib A, Patel R, Muir M, Gadot R, Briere T, et al. Fractionated stereotactic radiotherapy for local control of resected brain metastases. J Neurooncol. 2019;144((2)):343–50. PubMed