title: Brain metastases management paradigm shift: A case report and review of the literature.
abstract: Brain metastases are the most common intracranial tumors in adults, accounting for over half of all lesions. Whole-brain radiation therapy (WBRT) has been a cornerstone in the management of brain metastases for decades. Recently, stereotactic radiosurgery (SRS) has been considered as a definitive or postoperative approach instead of WBRT, to minimize the risk of cognitive impairment that may be associated with WBRT. This is the case report of a 74-year-old female patient who was diagnosed with lung cancer in November, 2002, and histopathologically confirmed brain metastases in January, 2005. The patient received 5 treatments with Gamma Knife SRS for recurring brain metastases between 2005 and 2014. The patient remains highly functional, with stable intracranial disease at 10 years since first developing brain metastases, and with stable lung disease. Therefore, Gamma Knife SRS is a safe and effective treatment modality for patients with recurrent intracranial metastases, with durable local control and minimal cognitive impairment.
authors.affiliation: Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL 606611, USA; Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Alexandria University, Alexandria 21561, Egypt; Northwestern Medicine Developmental Therapeutics Institute (NMDTI), Northwestern University, Chicago, IL 606611, USA.
authors.forename: Tamer
authors.initials: T
authors.lastname: Refaat
authors.affiliation: Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL 606611, USA.
authors.forename: Sean
authors.initials: S
authors.lastname: Sachdev
authors.affiliation: Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL 606611, USA.
authors.forename: Brijal
authors.initials: B
authors.lastname: Desai
authors.affiliation: Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL 606611, USA.
authors.forename: Ian
authors.initials: I
authors.lastname: Bacchus
authors.affiliation: Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL 606611, USA.
authors.forename: Saleh
authors.initials: S
authors.lastname: Hatoum
authors.affiliation: Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL 606611, USA.
authors.forename: Plato
authors.initials: P
authors.lastname: Lee
authors.affiliation: Department of Neurological Surgery, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL 606611, USA.
authors.forename: Orin
authors.initials: O
authors.lastname: Bloch
authors.affiliation: Department of Neurological Surgery, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL 606611, USA.
authors.forename: James P
authors.initials: JP
authors.lastname: Chandler
authors.affiliation: Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL 606611, USA.
authors.forename: John
authors.initials: J
authors.lastname: Kalapurakal
authors.affiliation: Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL 606611, USA.
authors.forename: Maryanne Hoffman
authors.initials: MH
authors.lastname: Marymont
keywords: Gamma Knife; brain metastases; radiosurgery