In April this year, a patient with a pineal region tumor came to consult me. He himself was a doctor. One year earlier, he had undergone Gamma Knife treatment for the pineal region tumor at another hospital, after which the tumor gradually disappeared. Unfortunately, the good condition did not last long. In January 2025, the tumor recurred. He then visited a well-known hospital and sought help from a neurosurgery expert, hoping for endoscopic tumor removal. After carefully reviewing his MRI scans, the expert refused to perform the surgery.

The patient's symptoms worsened—headache, progressive vision loss, nausea, and vomiting, followed by weight loss and unsteady gait. In April 2025, a follow-up MRI revealed new tumors in the sellar region, alongside the brainstem, and in the pineal region, compressing the optic nerve, with extensive leptomeningeal metastasis. Since there was no pathological diagnosis, the oncologist declined to administer chemotherapy.

The patient and his family came to me. I told them frankly that the tumor had already spread widely within the brain, and that the only possible option was to try whole-brain and whole-spinal radiotherapy combined with CyberKnife treatment. Seeing a glimmer of hope, the family pleaded with me to find a way to help.

We first used the CyberKnife to deliver high-dose irradiation to the larger intracranial tumors, followed by whole-brain and whole-spinal radiotherapy. The patient endured the treatment well, and his symptoms gradually improved—vision returned to normal, vomiting disappeared, and he was able to move freely (before treatment, he could only lie in bed and vomit frequently). Without a pathological diagnosis, I prescribed oral temozolomide for him.

After four months of comprehensive treatment, MRI follow-up showed that the tumors had almost completely disappeared, with only minimal residual lesions near the pineal region and beside the brainstem. I then performed an additional low-dose CyberKnife treatment for the residual tumor. Everything has so far progressed exactly as expected, and the patient is gradually returning to normal life.

This case reminded me of another pineal region (posterior third ventricle) tumor patient I treated 14 years ago with CyberKnife combined with conventional radiotherapy. At that time, I explained my treatment strategy to the patient's family:

CyberKnife delivers high-dose, highly precise radiation directly to the tumor, exerting strong tumor-killing power. However, it cannot cover the potential tumor cells around the periphery of the main lesion. Conventional radiotherapy, on the other hand, has a wider irradiation field, allowing it to cover potential microscopic tumor cells beyond the visible tumor. By perfectly combining the two techniques, we can kill both visible and potential tumor cells, while minimizing damage to normal brain tissue. The family accepted my treatment plan.

After CyberKnife treatment, the tumor gradually shrunk, and MRIs in 2023 and this year showed that the tumor remained almost completely resolved. However, hydrocephalus later developed, and I recommended surgical intervention to address it.

The following images show the MRI scans of these two patients. Through my WeChat posts, I hope to share and promote the advanced treatment concept of combining CyberKnife and radiotherapy for patients with complex malignant tumors, so that more patients may benefit from it.