The challenge: serving a large region with growing clinical complexity

In northern Poland, Centrum Onkologii im. prof. Franciszka Łukaszczyka w Bydgoszczy caters to a vast geographical region where many patients travel long distances for specialized care. As a center with extensive experience in treating tumors of the central nervous system, the demand for their services expanded, and the team faced a growing number of cases requiring high-quality radiosurgery.

Table 1: The number of SRS and SBRT treatments at the Oncology Center in Bydgoszczy has increased by almost 2,000% in less than a decade.

In 2024 alone, the team treated 340 patients with brain metastases, 71 with spinal metastases, 134 patients with meningiomas and 56 with vestibular schwannomas (VIII nerve)—plus over 350 extracranial cases.

Over more than 15 years, the center further developed their comprehensive SRS and SBRT program. What began in 2009 with BrainSCAN, the first treatment planning solution from Brainlab, continued through iPlan RT and has since evolved into the broad adoption of RT Elements across eight treatment machines, alongside Brainlab ExacTrac Dynamic. Increasing patient volumes as well as multifocal disease presentations pushed the team to refine workflows capable of handling high case complexity on a day-to-day basis.

As case numbers and complexity continued to rise, the team began to push conventional planning boundaries—not just in theory, but in daily clinical practice. One case treated in May 2025 became a clear example of how their approach could scale even to highly extensive disease presentations.

The case: planning for 34 brain metastases in a single patient

A 67-year-old man presented with headaches, nausea and vomiting. Imaging revealed 34 brain metastases along with an adrenal lesion associated with newly diagnosed lung adenocarcinoma. Despite the high lesion count, the patient’s clinical condition remained good, and systemic therapy offered a meaningful survival outlook. The team elected to pursue SRS for all intracranial lesions—an approach once considered impractical at this scale.

Using Brainlab Elements Multiple Brain Mets SRS, the clinicians were able to treat all lesions using only two isocenters during the same planning session:

• Isocenter 1: 10 targets
• Isocenter 2: 24 targets
• Total GTV: 18.6 cm³
• Total PTV: 26 cm³
• Dose: 25 Gy in 5 fractions

While highly complex, the case aligned with the department’s established planning and treatment workflow.

The impact: a strong clinical response at first follow-up

At the initial follow-up in September, the results were striking:

• 33 lesions demonstrated complete regression
• 1 lesion showed partial regression
• the patient reported no neurological deficits
• no steroid therapy was required
• and he remained asymptomatic

For the Bydgoszcz team, the case underscored a pattern they had observed across growing patient volumes: when planning tools support structured segmentation and a monoisocentric approach, lesion count becomes less of a technical barrier to delivering treatment.

Prof. Maciej Harat, MD, and Maciej Blok, PhD, MD, Centrum Onkologii Im. Prof. Franciszka Łukaszczyka W Bydgoszczy reflect on the experience: “This case showed us that the number of brain metastases is no longer the limiting factor for delivering focal treatments. Alongside these highly complex treatments, we are managing an increasing number of patients each year—and we would not be able to keep pace without Brainlab Elements. The software supports automatic segmentation of targets and organs at risk and helps us generate highly complex plans in a very short time.”

The team behind the progress: 25 radiation oncologists, 26 medical physicists, 38 radiation therapists and more clinical staff at Bydgoszcz have built a radiosurgery program capable of treating some of the region’s most complex cases. Their commitment ensures that patients across a large geographical area can access advanced, high-quality care.

Please join us in celebrating the team at Centrum Onkologii im. prof. Franciszka Łukaszczyka w Bydgoszczy for demonstrating how skills and well-established workflows can expand access to precise radiosurgery—no matter the complexity.