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Multimodality durable salvage of recurrent brain metastases refractory to LITT, SRS and immunotherapy with resection and cesium-131 brachytherapy: case report and literature review
  1. Kenny Kwok Hei Yu1,2,
  2. Brandon S Imber2,3 and
  3. Nelson S Moss1,2
  1. 1Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  2. 2Brain Metastasis Center, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  3. 3Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  1. Correspondence to Dr Nelson S Moss; mossn{at}mskcc.org

Abstract

Brain metastases (BrM) are treated with multimodality therapy, however the optimal combination and timing of modalities in the setting of recurrent tumours that have failed prior treatments remain poorly defined. We present a case of a patient with biopsy-confirmed renal cell carcinoma BrM with good performance status initially treated with laser interstitial thermal ablation therapy (LITT) followed by stereotactic radiosurgery and dual checkpoint inhibitor immunotherapy. He subsequently developed rapid in-field recurrence which was treated with salvage surgical resection and implantation of intracavitary cesium-131 brachytherapy. The patient’s disease remained stable through 18 months postoperatively. This case illustrates the range of options available and provides a combination salvage therapy strategy in a select group of locally recurrent patients who have exhausted conventional treatment options.

  • cancer intervention
  • neurooncology
  • CNS cancer
  • neurosurgery

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Footnotes

  • Twitter @Dr_N_Moss

  • Contributors KKHY collected data, assembled figures and wrote manuscript. BI supplied radiation dosimetry data and reviewed manuscript. NSM conceived paper, wrote and edited manuscript. All figures were illustrated and assembled by KY. Intraoperative images were provided by NM, brachytherapy dosimetry plan was provided by BI.

  • Funding This study was funded by National Cancer Institute, USA (Cancer Center Support Grant P30 CA008748).

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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