Complete remission of brain metastasis from thymic carcinoma following hypofractionated gamma knife radiosurgery: case report and a review of literature

Abstract

Introduction Thymic carcinoma is a rare, aggressive neoplasm that frequently metastasizes to the lungs, liver, and bones, but rarely to the central nervous system. Less than 50 cases of brain metastases from thymic carcinoma have been documented in the literature, and no consensus exists regarding their optimal management and follow-up.

Case presentation Here, we report the case of a 54-year-old male who developed a solitary metastasis in the right temporal region nearly four years after the diagnosis of metastatic thymic carcinoma. The lesion was discovered incidentally on follow-up PET-CT scan. He was treated with hypofractionated stereotactic radiosurgery (hSRS) alone. No surgical intervention or whole brain radiotherapy (WBRT) was performed. MRI showed near-complete regression of the lesion and cavity collapse at the first month, and complete remission was achieved at 4th months. The patient remains alive and recurrence-free at 17 months of follow-up.

Clinical discussion To date, only five cases have been reported in which stereotactic radiosurgery (SRS) was used as part of a multimodal approach, typically in combination with surgical resection, to achieve intracranial disease control. Notably, hSRS was employed in only two of these cases, both alongside surgery; however, neither achieved progression-free survival.

Conclusion This case demonstrates that Gamma Knife-based hSRS may achieve durable control of solitary brain metastases from thymic carcinoma without the need for surgery or WBRT. It also emphasizes the importance of long-term neuroimaging surveillance in thymic carcinoma due to the potential for delayed central nervous system dissemination.