Although (radio-) surgery was shown to provide excellent local control in up to 96% of the patients [ 1, 22], it would be expected that reduced overall survival of BM-patients is related to the tenuous site of metastases.
The exclusion criteria were the presence of endocrine disease, metastatic disease, inflammatory BC (T4d), history of thromboembolism and any previous treatment for BC (surgery, radio or chemotherapy).
For all residual cases, three cases had postoperative conventional radiotherapy, and three cases had gamma-knife radio-surgery radiation as they had financial resources' for such expensive therapy.
For residual cases (14.4%), 4.8% of patients had small residual (Simpson grade IV), with no tumor growth on their follow up; 4.8% had conventional radiation; 2.4% had re-surgery; and 2.4% had gamma-knife radio-surgery (Figs. 1 and 5).
It is also possible to administer radiotherapy, radio-surgery and image guided surgery beyond the first trimester.
Detection of CNS metastases was carried out by brain CT scan systematically followed by MRI in case of single lesions potentially amenable to surgery or radio-surgery treatment.
He was started on steroids and underwent stereotactic radio-surgery (SRS) to the skull base mass, with resolution of his headaches and diplopia.
CR, complete response; FSRT, fractionated stereotactic radiotherapy; GKS, gamma knife surgery; IT MTX, intrathecal methotrexate; PR, partial response; PD, progressive disease; SD, stable disease; SRS, stereotactic radio-surgery; WBRT, whole-brain radiotherapy; NE, not estimable.
More recently, the introduction of new techniques such as intensity modulated radiation therapy (IMRT) and stereo-tactic radio-surgery has led to the possibility to deliver high photons doses with sparing surrounding tissue resulting in improving treatment tolerability [ 24, 25].
"Radio-surgery" was a response to those surgeons who claimed that radiotherapy could not deal with the lymphatic glands, but the insertion of needles did increase the risk of septic infection, which was one of the most common causes of death after radiotherapy.
