At the end of August this year, Xuanwu Hospital held a neurosurgery study session. I was assigned to deliver a lecture on "Treatment Options for Large Brain Metastases with Severe Cerebral Edema". While preparing the materials, I recalled a particular patient.

Three years after undergoing surgery for lung cancer, she developed multiple intracranial metastases accompanied by severe cerebral edema. One lesion was located in the right functional area, and the patient exhibited left lower limb weakness. The extensive edema caused by the left-sided metastasis resulted in slurred speech. Her son came to my outpatient clinic to discuss treatment options. Considering the patient's advanced age, they preferred to avoid chemotherapy.

My proposed treatment strategy was as follows:

Comprehensive assessment:

1. Perform a whole-body PET-CT to evaluate systemic metastases. If metastases were confined to the brain, I recommended high-dose CyberKnife stereotactic radiosurgery (SRS).

2. Enhancement of the patient's immune function and resistance:

Maintain good nutrition and sleep to strengthen immunity.

Encourage physical activity to enhance resilience.

Consider thymosin supplementation to further boost immune function.

Following the first CyberKnife treatment, a single dose of bevacizumab was administered immediately to alleviate cerebral edema. The patient's hemiplegia and speech difficulties rapidly returned to normal. Subsequent MRI follow-ups were performed every three months.

Two and a half years after the initial treatment, new brain metastases appeared, and a second CyberKnife session was performed. Following this session, the patient experienced a right-sided cerebral infarction, resulting in reduced mobility of the left lower limb. Five and a half years after the first CyberKnife treatment, additional multiple intracranial metastases emerged, prompting a third CyberKnife session.

After three courses of CyberKnife treatment, the patient achieved seven and a half years of high-quality life.

Since the late 1990s, I have followed a large cohort of elderly patients (aged 75–80) with brain metastases treated with either Gamma Knife or CyberKnife. When treated solely with these local therapies, patients generally experienced longer survival. In contrast, combining with chemotherapy often resulted in premature death due to treatment-related complications.

Thus, for elderly patients with brain metastases—whether single or multiple lesions—and without systemic metastatic disease, local treatment with Gamma Knife or CyberKnife remains one of the optimal strategies for achieving long-term, high-quality survival.