Multiple brain metastases from primary gall bladder carcinoma treated by sequential surgery, radiotherapy and chemotherapy

Gallbladder carcinoma tends to be an aggressive tumour that spreads early and leads to rapid death after diagnosis as compared to other gastrointestinal carcinomas. Brain metastasis in such patients further cuts short their life. The common metastasis sites from carcinoma of the gallbladder are liver, regional lymphnodes; and peritoneum. The only common extra-abdominal sites of metastasis are lungs and at few occasions skeletal system. Systemic metastases from gallbladder carcinoma occur frequently, but involvement of the central nervous system is a rarity. Surgery has shown to be a viable approach in solitary brain metastasis but multiple brain metastases are difficult to treat. In patients with multiple metastases, surgery, radiation therapy or chemotherapy alone or in combination are the options available. The treatment plan in patients with multiple metastases needs to be individualized keeping in mind various tumor and patient factors. Such individualized treatment can provide palliation to patients with improvement of quality of life; without adding to treatment related complications. Here, we present a case of carcinoma of the gallbladder with two foci of brain metastases managed with combination treatment of surgery, chemotherapy and radiotherapy. She tolerated whole treatment well without any complications. Thirteen months after her treatment, she is currently asymptomatic and is on regular follow-up.