Suprasellar non-small cell lung carcinoma metastasis – upfront radiosurgery





















SKULL BASE REGION Suprasellar
HISTOPATHOLOGY Metastasis, non–small cell lung carcinoma
PRIOR SURGICAL RESECTION No – only biopsy
PERTINENT LABORATORY FINDINGS N/A


Case description


The patient is a 79-year-old woman with a 3-year history of non–small cell lung carcinoma, status post right upper lung lobectomy. She presented with episodes of progressive nausea and vomiting and was found to have diabetes insipidus. Imaging revealed a 1-cm enhancing lesion in the suprasellar region, adjacent to the optic chiasm and hypothalamus ( Figure 4.19.1 ). A stereotactic biopsy ( Figure 4.19.2 ) confirmed the diagnosis of a non–small cell lung metastasis, and the patient elected for stereotactic radiosurgery (SRS) ( Figure 4.19.3 ).














Radiosurgery Machine CyberKnife
Radiosurgery Dose (Gy) 25, at the 71% isodose line
Number of Fractions 5



Figure 4.19.1.


Preoperative postcontrast axial, sagittal, and coronal imaging showing a 10-mm enhancing lesion on the undersurface of the optic chiasm and hypothalamus with a slight local mass effect, as well as mass effect onto the recess of the third ventricle.



Figure 4.19.2.


Preradiosurgery, postcontrast axial, sagittal, and coronal imaging following biopsy demonstrating a 7-mm enhancing suprasellar mass. Significant motion artifact is noted.



Figure 4.19.3.


Imaging of the treatment plan.






















Critical Structure Dose Tolerance
Optic nerve/chiasm <5 Gy maximum point dose
Brainstem


  • 15 Gy maximum point dose



  • <1 cc >10 Gy

Cranial nerves in cavernous sinus


  • Unknown but significantly more resistant than optic nerve



  • Can be more sensitive if stereotactic radiosurgery (SRS) follows another form of radiation

Cavernous carotid artery


  • Very tolerant



  • No evidence of SRS-induced stenosis

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Apr 6, 2024 | Posted by in GENERAL RADIOLOGY | Comments Off on Suprasellar non-small cell lung carcinoma metastasis – upfront radiosurgery

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