Unexpected Daily Changes in Tumor Volume during Fractionated Gamma Knife Radiosurgery for Solitary Intraventricular Metastatic Renal Cell Carcinoma: A Case Report

Haewon Roh, Junwon Kim, Kyuha Chong, Won Ki Yoon, Taek Hyun Kwon, Jong Hyun Kim

    Research output: Contribution to journalArticlepeer-review

    1 Citation (Scopus)

    Abstract

    For most fractionated stereotactic radiosurgery treatment plans, daily imaging is not routinely performed, because there is little expectation that lesions will change significantly in the short term. However, here, we present the case of an abrupt increase and decrease in tumor volume during fractionated gamma knife radiosurgery (GKRS) for metastatic brain cancer. A 65-year-old man with a history of nephrectomy due to renal cell carcinoma was admitted to our hospital because of mild cognitive disorder and gait disturbance. An initial MRI of the brain demonstrated a 5 × 3 × 4.5 cm-sized, heterogeneously well-enhanced tumor with a large cystic component compressing the left thalamus and corpus callosum near the lateral ventricle. Owing to its large size and proximity to critical structures, we decided to perform 3 fractionated GKRSs over 3 consecutive days. After the first fraction of 9 Gy with 50% isodose, follow-up MRI the next day revealed an unexpected increase in tumor volume up to 30%. Therefore, the radiosurgical plan was adjusted, and GKRS was performed again using the same dose for the second fraction. The image taken on the third day showed rapid shrinkage of the tumor volume. This case shows that a tumor may change its shape and volume unexpectedly even during the short period of a fractionated GKRS session. Hence, for optimal fractionated GKRS treatment of tumors with the likelihood of an abrupt change in the short term, interval imaging should be considered.

    Original languageEnglish
    Pages (from-to)44-48
    Number of pages5
    JournalStereotactic and Functional Neurosurgery
    Volume97
    Issue number1
    DOIs
    Publication statusPublished - 2019 May 1

    Keywords

    • Fractionated stereotactic radiosurgery • Fractionated gamma knife radiosurgery • Renal cell carcinoma • Choroid plexus • Interval imaging

    ASJC Scopus subject areas

    • Surgery
    • Clinical Neurology

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