Stereotactic Radiosurgery for the Management of Brain Metastases

A 50-year-old man with a history of locally advanced non-small-cell lung cancer presents with moderately severe headaches and mild numbness of the right arm. He is functionally independent and has no coexisting medical conditions. His neurologic examination is normal except for some diminished sensation in the right arm. Magnetic resonance imaging (MRI) of the brain reveals a single lesion, 2.5 cm in diameter, in the left parietal region, with a moderate amount of edema. Additional testing shows no evidence of extracranial disease. He is treated with dexamethasone, with rapid improvement of his symptoms. His physicians recommend whole-brain radiation therapy followed by stereotactic radiosurgery.