53yo with intermittent speech problems
•PMH is otherwise unremarkable
•Neurologically intact except for mild word finding difficulty
Questions seem to be leading. Question 4 is confusing at best.
I hope to improve my knowledge. Best Regards, Tomasz Skaba
Prognosis is poor in spite of all available treatment modalities.
I would have advised CT/PET Scan of the body before getting CT Scan of a particular part
Case Explanation: Explanation of Answers
1. The patient has a history of renal cell carcinoma therefore re-staging his cancer by obtaining a CT of his chest/abd/pelvis would be prudent prior to treating his brain lesion. The presence of wide-spread metastatic disease would potentially change your treatment plan. The diagnosis of multiple myeloma, infection and demyelinating disease are less likely.
2. The most common types of cancer to result in brain metastasis are lung cancer, breast cancer, and melanoma. Colon, prostate and renal cell have a much lower incidence of brain metastases.
3. SRS doses for brain metastasis are usually 20Gy for a single isocenter (smaller lesions) and 17.5Gy for multiple isocenters (larger lesions).
4. Radiation necrosis can be treated with hyperbaric oxygen treatment, surgical resection or MRI guided laser ablation (laser interstitial thermotherapy). Continuing steroids for more than 4 weeks is unlikely to result in resolution of the lesion and edema.
•Stelzer et al. Epidemiology and prognosis of brain metastasis. Surg Neurol Int 2013.
•Rahman et al. Radiographic response of brain metastasis after LINAC radiosurgery. Stereotact Funct Neurosurg 2012.
•Shaw et al. Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and metastases: Final report of RTOG protocol 90-05. Int J Radiat Oncol Biol Phys 2000.
•Torres-Reveron et al. Stereotactic laser induced thermotherapy (LITT): a novel treatment for brain lesions regrowing after radiosurgery. J Neurooncol 2013.