77-year old female patient, with soliter cerebral metastasis; she had been treated for synchron breast and colon tumors previously.

2010 February: quadrantectomy mammae+SNB (multifocal IDC+DCIS pT1pT1pT1pTis, pn0 (0/2) (sn) ER:50%, PR: 80%, HER2: neg., resection margin 2 mm). She received postoperative RT (25x2 Gy operated breast and 5x2 Gy tumor bed boost), and adjuvant endocrine therapy with aromatase inhibitor.

2010 July: right hemicolectomy (adenoc. pT3 pN0). No adjuvant therapy was given.

In 2012 autumn, se experienced deterioration of per erformance status, and transitory aphasia, and imaging studies were executed. Chest CT: multiple pulmonary metastases, cerebral CT: soliter metastasis int he right frontal lobe (Figure 1).

The following questions raise:

Which tumor is the source of the metastasis?

One way to prove it, is biopsy. However, since stereotactic biopsy means surgery with its risks, the patient is old, and pulmonary metastases are present which limit the curativeness of the intent to treat, the option of biopsy was not considered.

Tumor markers CEA: elevated, CA 15-3: normal suggest that the colon tumor is disseminated

Therapy: palliative brain RT (10x3 Gy whole brain plus 10x2 Gy tumor/GTV) was given (Figure 2 | Figure 3). Later on, palliative chemotherapy with capecitabine is planned if the performance status of the patient permits it.

Edited by Dr. Linda Varga