Solitary Splenic Metastasis from Gastric Adenocarcinoma Treated with Stereotactic Body Radiotherapy using Deep Inspiratory Breath Hold

Splenic metastases are rarely caused by non-hematologic malignancies, and only 6.9% of these metastases have a gastric origin. Stomach cancer splenic metastases are rare and often asymptomatic. The conventional therapy of choice is splenectomy. However, few instances are documented where stereotactic body radiation (SBRT) was used to treat isolated splenic metastases from gastric cancer. We present a case of solitary splenic metastasis from gastric adenocarcinoma treated with SBRT using deep inspiratory breath hold (DIBH). A woman in her fifties, previously treated with subtotal gastrectomy and adjuvant chemotherapy for pT4aN0M0 gastric cancer, presented with a positron emission tomography-avid solitary splenic lesion 2 years later. Following multidisciplinary discussion, SBRT with DIBH (50 Gray/5 fractions) was delivered along with daily cone beam computed tomography. The patient tolerated treatment well, with stable disease and no haematological toxicity. This case highlights SBRT as a non-invasive, feasible option for local control of isolated splenic metastasis from gastric carcinoma.