{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T11:13:44Z","timestamp":1783682024614,"version":"3.55.0"},"reference-count":21,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and Clinical Significance: Brain metastases in non-small cell lung cancer (NSCLC) carry a poor prognosis, particularly in patients lacking targetable driver mutations or significant programmed death-ligand 1 (PD-L1) expression. Durable intracranial control exceeding five years is uncommon in this population and the factors that determine exceptional therapeutic response remain incompletely understood; Case Presentation: We report a 59-year-old male with pathological stage pT3N1 solid-type pulmonary adenocarcinoma (EGFR wild-type, ALK wild-type, PD-L1 &lt;1%) who developed two sequential brain metastases following right upper lobectomy and adjuvant pembrolizumab plus pemetrexed-carboplatin. The first lesion was treated with single-fraction stereotactic radiosurgery (SRS, 10 Gy); a second metastasis identified 18 months later was managed with focal radiotherapy (8 Gy, single fraction) followed by whole-brain radiotherapy (24 Gy in 12 fractions). Local progression of the second metastasis in 2024 prompted successful surgical resection via right occipital craniotomy. Over a follow-up exceeding five years, the patient achieved sustained intracranial disease control, preserved neurological function, and maintained quality of life. Notably, no clinically apparent neurocognitive deterioration was documented on routine clinical follow-up, despite whole-brain irradiation without hippocampal sparing; formal neuropsychological testing was not performed; Conclusions: This case demonstrates that durable intracranial control may be achievable through carefully sequenced multimodal therapy\u2014including stereotactic radiosurgery, whole-brain radiotherapy, and neurosurgical resection\u2014even in biologically unfavorable NSCLC. The absence of clinically apparent neurocognitive deterioration on routine follow-up after WBRT raises hypothesis-generating questions regarding interindividual variability in radiation tolerance; this observation must be interpreted in the absence of formal neuropsychological testing and prospective hippocampal dosimetry. A multidisciplinary, individualized approach integrating radiotherapy, systemic therapy, and neurosurgery remains essential in this setting.<\/jats:p>","DOI":"10.3390\/reports9030220","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T09:46:47Z","timestamp":1783676807000},"page":"220","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Durable Intracranial Control Beyond Five Years in EGFR Wild-Type Non-Small Cell Lung Cancer with Sequential Brain Metastases Managed with Multimodal Therapy: A Case Report"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1601-0580","authenticated-orcid":false,"given":"Mihai-Teodor","family":"Georgescu","sequence":"first","affiliation":[{"name":"Oncology 2 Discipline, Department 8, Faculty of Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Radiotherapy 2, \u201cProf. Dr. Alexandru Trestioreanu\u201d Oncology Institute, 022328 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrada Maria","family":"B\u0103rbu\u021b","sequence":"additional","affiliation":[{"name":"Radiotherapy 2, \u201cProf. Dr. Alexandru Trestioreanu\u201d Oncology Institute, 022328 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.bbcan.2016.12.001","article-title":"Brain metastasis: Unique challenges and open opportunities","volume":"1867","author":"Lowery","year":"2017","journal-title":"Biochim. Biophys. Acta Rev. Cancer"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S192","DOI":"10.4103\/2152-7806.111296","article-title":"Epidemiology and prognosis of brain metastases","volume":"4","author":"Stelzer","year":"2013","journal-title":"Surg. Neurol. Int."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1016\/j.nec.2020.06.001","article-title":"Epidemiology of brain metastases","volume":"31","author":"Sacks","year":"2020","journal-title":"Neurosurg. Clin. N. Am."},{"key":"ref_4","first-page":"85","article-title":"Optimal management of brain metastases in oncogenic-driven non-small cell lung cancer (NSCLC)","volume":"131","author":"Andratschke","year":"2019","journal-title":"Lung Cancer"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e373","DOI":"10.1016\/j.cllc.2018.01.007","article-title":"Non-small-cell lung cancer with brain metastasis at presentation","volume":"19","author":"Waqar","year":"2018","journal-title":"Clin. Lung Cancer"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s12987-025-00618-z","article-title":"Breaking boundaries: Role of the brain barriers in metastatic process","volume":"22","author":"Izadi","year":"2025","journal-title":"Fluids Barriers CNS"},{"key":"ref_7","first-page":"65","article-title":"Tumor microenvironment in lung cancer-derived brain metastasis","volume":"89","author":"Liu","year":"2023","journal-title":"Semin. Cancer Biol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3773","DOI":"10.1200\/JCO.20.01255","article-title":"Survival in patients with brain metastases: Summary report on the updated diagnosis-specific Graded Prognostic Assessment and definition of the eligibility quotient","volume":"38","author":"Sperduto","year":"2020","journal-title":"J. Clin. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/S1470-2045(19)30801-0","article-title":"Patient-reported outcomes following pembrolizumab or placebo plus pemetrexed and platinum in patients with previously untreated, metastatic, non-squamous NSCLC (KEYNOTE-189)","volume":"21","author":"Garassino","year":"2020","journal-title":"Lancet Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Wu, D., Huang, Y., Wang, B., Zheng, Q., Wang, T., Zhou, J., and Mei, J. (2025). A clinical model to predict brain metastases in resected early-stage non-small cell lung cancer. BMC Cancer, 25.","DOI":"10.1186\/s12885-025-13609-y"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1093\/neuonc\/nou099","article-title":"Incidence of brain metastasis at initial presentation of lung cancer","volume":"17","author":"Villano","year":"2015","journal-title":"Neuro-Oncology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"108745","DOI":"10.1016\/j.lungcan.2025.108745","article-title":"Clinical risk factors for developing brain metastases during first-line (chemo-)immunotherapy in patients with non-small cell lung cancer without known baseline brain metastases","volume":"208","author":"Huijs","year":"2025","journal-title":"Lung Cancer"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/j.immuni.2018.03.007","article-title":"Combination cancer therapy with immune checkpoint blockade: Mechanisms and strategies","volume":"48","author":"Patel","year":"2018","journal-title":"Immunity"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"djv059","DOI":"10.1093\/jnci\/djv059","article-title":"Lung cancer prognosis before and after recurrence in a population-based setting","volume":"107","author":"Consonni","year":"2015","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_15","first-page":"101362","article-title":"Stereotactic radiosurgery in the management of brain metastases: A case-based Radiosurgery Society practice guideline","volume":"9","author":"Ladbury","year":"2024","journal-title":"Adv. Radiat. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2026","DOI":"10.1200\/JCO.2024.42.16_suppl.2026","article-title":"Radiosurgery to 5 or more newly diagnosed brain metastases in the systemic therapy era","volume":"42","author":"Beckham","year":"2024","journal-title":"J. Clin. Oncol."},{"key":"ref_17","first-page":"127","article-title":"Hippocampal-sparing whole-brain radiotherapy for lung cancer","volume":"108","author":"Zhao","year":"2017","journal-title":"OncoTargets Ther."},{"key":"ref_18","first-page":"249","article-title":"Surgery, stereotactic radiosurgery, and systemic therapy in the management of operable brain metastasis","volume":"33","author":"Kotecha","year":"2022","journal-title":"Neurosurg. Clin. N. Am."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1186\/s13244-025-02125-z","article-title":"Assessing brain metastasis response to immunotherapy: A pictorial review of atypical responses and intracranial adverse events","volume":"16","author":"Amseian","year":"2025","journal-title":"Insights Imaging"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Olayode, O.O., Ogunoye, B.T., Oladeji, E.O., Olayinka, O.E., and Oladosu, T.J. (2025). Cerebrospinal fluid circulating tumor DNA (ctDNA) as a biomarker for CNS metastases in non-small cell lung cancer: A systematic review and meta-analysis. Diagnostics, 15.","DOI":"10.1186\/s12885-025-14583-1"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e2400921","DOI":"10.1200\/PO-24-00921","article-title":"Minimum technical preanalytical, patient, and clinical context data elements for cerebrospinal fluid liquid biopsy","volume":"9","author":"Bagley","year":"2025","journal-title":"JCO Precis. Oncol."}],"container-title":["Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2571-841X\/9\/3\/220\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T10:23:30Z","timestamp":1783679010000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2571-841X\/9\/3\/220"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,10]]},"references-count":21,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["reports9030220"],"URL":"https:\/\/doi.org\/10.3390\/reports9030220","relation":{},"ISSN":["2571-841X"],"issn-type":[{"value":"2571-841X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,10]]}}}