Patient Plan Customization in Hypofractionated CyberKnife Radiosurgery for Extensive Brain Metastases Within a Resource-Constrained Low-Middle-Income Country

Brain metastasis (BM) carries a dismal prognosis. In the setting of advanced breast cancer, BM has a formidable outcome, yet radiosurgery has played a pivotal role in palliating patients. Here, we present the case of a 62-year-old hypertensive female with biopsy-proven, triple-negative, invasive ductal carcinoma of the left breast (stage IV disease). Whole-brain radiotherapy (WBRT) failed to achieve radiological and clinical response for 60 intracranial metastatic space-occupying lesions. Her presenting complaint of intractable headache was accompanied by a normal neurological examination. A customized plan for stereotactic radiosurgery via CyberKnife S7 was utilized with a 2,200 cGy dose and 68% isocurve over five fractions on alternate days. Redo WBRT was not performed owing to the patient's comorbidities, age, and risk of cognitive deficits. Radiological remission of 81% and 88% with no neurological deficits was achieved at the fourth and eighth months of follow-up. To our knowledge, this is the first case of 60 secondaries in the human brain from a breast primary successfully managed with CyberKnife stereotactic radiosurgery, achieving remarkable radiological regression while preserving clinical function. A customized plan considering the patient's factors and risk versus benefit assessment is advisable in all cases of metastatic brain disease.