How would you manage a patient with limited dural-based metastases?

Pachymeningeal (dural) metastases come in 3 varieties – distinguishing these entities is important therapeutically.

1. Calvarial metastases with secondary pachymeningeal (dural) extension – these tumors can be thought of as bony metastases and can sometimes be monitored on systemic therapy if modest in...

Dural-based metastases behave more like parenchymal brain metastases. These are not necessarily leptomeningeal in nature and do not need to be treated with whole-brain radiation. As such if limited in number, our approach has been to treat these with stereotactic radiosurgery if there is no other ev...