ArticleFrontiers in oncology2026
Case Report: Simultaneous stereotactic re-irradiation using HyperArc for 44 brain metastases after whole-brain radiotherapy.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Treatment options for disseminated intracranial recurrence after whole-brain radiotherapy (WBRT) are limited. Repeat WBRT offers modest efficacy and may worsen neurocognitive function. Modern single-isocenter techniques such as HyperArc may enable efficient stereotactic radiotherapy (SRT) of numerous brain metastases. Case presentation: A 62-year-old man with extensive-stage small-cell lung cancer and more than 40 brain metastases received systemic therapy followed by WBRT with 30 Gy in 10 fractions, resulting in near-complete intracranial regression. Approximately ten months later, magnetic resonance imaging revealed 41 new lesions and progression of 3 previously detected metastases. Because of his excellent performance status, all 44 lesions were treated with fractionated HyperArc SRT using 21.0 Gy in 3 fractions. Standardized neurocognitive testing was performed before SRT and repeated after 4 and 12 weeks. It demonstrated only selective deterioration without global or subjectively relevant impairment. Follow-up imaging after subsequent initiation of tarlatamab showed marked regression after 4 weeks and near-complete response after 3 months. Two additional lesions were subsequently treated with SRT, followed 7 months later by a second HyperArc course for 8 new metastases. At last follow-up, no treated lesion had locally recurred, and no radiographic radionecrosis was observed. Conclusion: Fractionated single-isocenter HyperArc SRT may represent a feasible salvage option for carefully selected patients with extensive intracranial recurrence after WBRT. The observed local control and limited neurocognitive deterioration support further prospective evaluation of this approach.
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