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Current treatment protocols advocate for whole brain radiotherapy (WBRT) for patients who are not candidates for either surgical resection or stereotactic irradiation. However, cognitive decline remains a major side effect of this treatment modality. Hippocampal\u2010sparing WBRT (HA\u2010WBRT) has been shown to decrease brain toxicity, with the main concern being the probability of developing new brain metastasis in the hippocampal avoidance region.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case<\/jats:title><jats:p>We report a case of a 73\u2010year\u2010old male presenting with multiple brain metastases and treated with HA\u2010WBRT, who then developed a new single pontine lesion shortly after that was found to be located in an under\u2010dosed peri\u2010hippocampal area. We dosimetrically compared the patient's original IMRT plan to three new plans: a standard VMAT plan, an optimized IMRT plan, and an optimized VMAT plan, where optimization incorporated brainstem coverage as a planning objective, resulting in a notable improvement in brainstem dose distribution.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>HA\u2010WBRT poses a risk of peri\u2010hippocampal metastasis due to underdosing of the upper brainstem that is inherent in HA\u2010WBRT plans. Planning techniques should focus on optimizing coverage of the brainstem in an attempt to decrease this uncommon occurrence.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cnr2.70323","type":"journal-article","created":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T06:56:16Z","timestamp":1756104976000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Single Pontine Relapse Shortly After Hippocampal Avoidance Whole Brain Radiotherapy: A Case Report"],"prefix":"10.1002","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-2975-2597","authenticated-orcid":false,"given":"Zeinab","family":"Dandash","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology American University of Beirut Medical Center  Beirut Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3960-8155","authenticated-orcid":false,"given":"Bassem","family":"Youssef","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology American University of Beirut Medical Center  Beirut Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1781-6152","authenticated-orcid":false,"given":"Ali","family":"Al Zein","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology American University of Beirut Medical Center  Beirut Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0633-2538","authenticated-orcid":false,"given":"Arafat","family":"Tfayli","sequence":"additional","affiliation":[{"name":"Division of Hematology\u2010Oncology American University of Beirut Medical Center  Beirut Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1267-3965","authenticated-orcid":false,"given":"Toni","family":"Tannoury","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology American University of Beirut Medical Center  Beirut Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4508-2391","authenticated-orcid":false,"given":"Lara","family":"Hilal","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology American University of Beirut Medical Center  Beirut Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,8,24]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.2217\/cns.14.51"},{"volume-title":"Brain Metastasis","year":"2023","author":"Kim M. 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