Abstract
IntroductionPost-stereotactic radiation-induced neoplasms, although relatively rare, have raised the question of benefit regarding CyberKnife® treatments versus the risk of a secondary malignancy. The incidence of such neoplasms arising in the nervous system is thought to be low, given the paucity of case reports regarding such secondary lesions.Case presentationHere we describe a case of a 43-year-old Middle Eastern woman with primary clear cell renal cell carcinoma and a metastatic focus to the left brain parenchyma who presented with focal neurologic deficits. Following post-surgical stereotactic radiation in the region of the brain metastasis, the patient developed a secondary high-grade astrocytoma nearly 5 years after the initial treatment.ConclusionAlthough the benefit of CyberKnife® radiotherapy treatments continues to outweigh the relatively low risk of a radiation-induced secondary malignancy, knowledge of such risks and a review of the literature are warranted.
Highlights
Post-stereotactic radiation-induced neoplasms, relatively rare, have raised the question of benefit regarding CyberKnifeW treatments versus the risk of a secondary malignancy
Given the advent of new stereotactic radiosurgery techniques, important questions have arisen regarding the risk of secondary malignancy following such treatments
We present a case of radiation-induced glioma in a patient following treatment with stereotactic radiosurgery for a metastatic renal cell carcinoma focus to the brain
Summary
Given the advent of new stereotactic radiosurgery techniques, important questions have arisen regarding the risk of secondary malignancy following such treatments. A magnetic resonance imaging (MRI) scan of her brain demonstrated a lesion in the left frontal lobe consistent with a possible metastasis, and an abdominal computed tomography showed an 8cm mass in the right kidney. She underwent a radical laparoscopic nephrectomy a month later, and surgical pathology revealed clear cell renal cell carcinoma (Figure 1) of Fuhrman nuclear grade 3 without evidence of metastasis to perinephric fat, the adrenal gland, renal vasculature, or hilar lymph nodes. The molecular immunology Borstel-1 (MIB-1) proliferation index was found to be 20% (Figure 3F)
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