Intratumoral Hemorrhage in a Brain Metastasis from Breast Cancer during Combination Chemotherapy and Stereotactic Radiotherapy—A Case Report—

Abstract

A 50-year-old woman diagnosed with bilateral breast cancer (right : cStage IIIB, luminal HER2^- ; left : cStage IIA, luminal HER2⁺) underwent preoperative antitumor treatment followed by bilateral mastectomy with right axillary lymph node dissection and left sentinel lymph node biopsy. Postoperative therapy consisted of radiotherapy for the right thoracic wall supraclavicular lymph node (50 Gy/25 fractions), followed by trastuzumab plus TS-1. One year postoperatively, recurrence appeared in the skin of the right upper arm and armpit (luminal HER2^-), and the regimen was switched to letrozole, but after 1 year of treatment, hepatic metastasis (luminal HER2^-) developed, and treatment was switched to fulvestrant plus palbociclib. Three months after the start of this regimen, the hepatic metastasis had progressed, and lung metastasis had also appeared ; treatment was therefore switched to everolimus plus exemestane. A brain metastasis measuring approximately 2 cm appeared in the parietal lobe 2 years and 10 months postoperatively, and weekly paclitaxel (wPTX) with stereotactic radiotherapy (40 Gy/5 fractions) was therefore scheduled. The wPTX dose (second dose) was combined with the second radiotherapy session, and the day after the fourth radiotherapy session, the patient noticed weakness of the left arm and leg. Cranial contrast-enhanced computed tomography showed suspected intratumoral hemorrhage in the brain metastasis. On the same day, a neurosurgeon was consulted, and an emergency craniotomy was performed to remove the tumor and hematoma. There have been few reports of intratumoral hemorrhage during stereotactic radiotherapy, and this case is reported with a short discussion of the literature.