Radiation Therapy for Surgically Resected Brain Metastasis: What Is Your Approach?

      A 70-year-old female patient with a history of locally advanced breast cancer presented with a 2-month duration of persistent gait imbalance. Ten years earlier, she initially received a diagnosis of an invasive ductal carcinoma of the right breast, triple negative, treated with mastectomy and axillary lymph node dissection, followed by adjuvant chemotherapy and postmastectomy radiation therapy. She had been followed up without evidence of disease until the present time. Magnetic resonance imaging of the brain demonstrated a lobulated enhancing mass measuring 3.6 × 2.4 × 3.6 cm involving the cerebellar vermis with a mass effect on the pons (Fig. 1). She proceeded to undergo a suboccipital craniotomy with resection of this mass, with pathologic findings demonstrating poorly differentiated adenocarcinoma, consistent with triple-negative breast primary cancer. Postoperative magnetic resonance imaging demonstrates linear enhancement around the resection bed consistent with postoperative changes, with resolution of the prior mass effect on the brainstem (Fig. 2); the resection cavity measures approximately 12 cm3. Restaging imaging demonstrates no evidence of extracranial disease, and the patient has recovered well from surgery with no residual neurologic deficits.
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      Fig. 1Selected axial images from preoperative T1 postcontrast magnetic resonance imaging sequence.
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      Fig. 2Selected axial images from postoperative T1 postcontrast magnetic resonance imaging sequence.
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