INITIAL HFRT EXPERIENCE ON TREATING LARGE BRAIN METASTASES LESION: A CASE REPORT

Abstract

Abstract Background: Brain metastases in cancer patients are increasing, due to advances in imaging and systemic treatment. Stereotactic Radiosurgery (SRS) is a high-end radiotherapy technique that is preferred to treat small brain metastases. Hypofractionated Radiotherapy (HFRT) is an alternative technique that demand lower requirements and ideal for treating larger brain metastases. This case report intended to report our institution initial experience using HFRT in limited setting to treat a patient with large brain metastases.  Case Presentation: A-43 years old women with previous breast cancer history was admitted with general weakness and severe headache since 2 weeks before admission. A CT scan exam shows multiple metastatic lesions on both parietal lobe, the largest lesion measures ≥ 3cm in diameter with a prominent vasogenic edema that caused lateral ventricle compression and mild midline shift. Discussion: SRS is preferred to treat brain metastases due to its efficacy and excellent therapeutic ratio. Unfortunately it has limitation in treating large metastatic lesions. For such lesions, HFRT being a simpler radiation technique can be opted to achieve acceptable local control and low toxicities profile. We use HFRT to treat a patient with large brain metastases lesion using IMRT with 10 x 4Gy fractionation scheme. The evaluation results 6 weeks later shows no viable brain lesion without any cognitive deterioration reported. Conclusion: HFRT for large brain metastases treatment is safe and viable to conduct in institution with limited resources. This relatively simpler technique compared to SRS should be considered to achieve acceptable therapeutic ratio with minimal toxicities.