Management of an Unusual Central Nervous System Metastasis With Linear Accelerator Radiosurgery in a Low-Middle Income Country

Large cell neuroendocrine carcinoma, a type of non-small cell lung cancer, is quite rare and has been associated with brain metastasis, mainly to the cerebral hemispheres. However, the rate of cerebellar metastasis is underreported in the literature and appears to be quite rare. Despite the rarity of this metastasis, treatment guidelines for both supratentorial and cerebellar lesions have been established by using either radiosurgery or whole-brain radiation therapy. The choice of modality must take into consideration the vicinity of relevant structures such as the brainstem and its multiple nuclei. Here we report the case of a 68-year-old male, resident of a rural community in the Andean region of Ecuador, a low-middle income country; with the diagnosis of a large cell neuroendocrine carcinoma of the lung with dual central nervous system metastasis treated with linear particle accelerator radio-surgery due to its versatility and cost-effectiveness in a resource-limited setting. We showcase the rarity of the metastatic lesions as well as the utility of linear accelerators and their versatility to perform precise radiosurgical procedures in two simultaneous locations.