Figure 2 | Scientific Reports

Figure 2

From: Histopathology and surgical outcome of symptomatic treatment-related changes after gamma knife radiosurgery in patients with brain metastases

Figure 2

An illustrative case of TRC-PD. A 73-year-old male patient with non-small cell lung cancer was diagnosed with a 2.9 cm brain metastatic lesion in the left temporo-occipital junction (A). GKS with an initial prescription dose of 20 Gy at 50% IDL was performed. Due to suspicion of tumor progression at 11 months after the first session, a secondary prescription dose of 17 Gy at 50% IDL was administered (B, IDL of the second GKS [yellow] and previous session [blue]). At 9 months from the last GKS, the patient visited the emergency room with IICP signs, and MRI showed a lesion resembling TRC with no distinct increase in rCBV and absence of restricted diffusion (C–E). Surgical resection was conducted and the pathology was confirmed to be a pure metastatic tumor cells. Without adjuvant local therapy for the resected lesion, the patient was free of local progression for 15 months (F). IDL isodose line, IICP increase of intracranial pressure, PD progressive disease, rCBV relative cerebral blood volume, TRC treatment-related image change.

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