Radiology and radiation treatment plans for metastatic lesions. Preoperative MRI scan demonstrating recurrent lesions in the right temporal subcutaneous space and right cerebellum is shown in (A) axial, (B) sagittal, and (C) coronal planes. Radiation treatment plan for these lesions is displayed on postoperative CT simulation scan in (D) axial, (E) sagittal, and (F) coronal planes, and on preoperative MRI in (G) axial, (H) sagittal, and (I) coronal planes. The patient was treated with hypofractionated radiation therapy to right temporal and right cerebellar recurrent lesions at a dose of 40.05 Gy (RBE) in 2.67 Gy per fraction. Following completion of this course of radiation, MRI of the spine (J) demonstrated a single small enhancing intradural, extra medullary lesion within the dorsal aspect of the spinal canal at the T1 level, consistent with drop metastasis. Patient was treated with proton radiation to entire thecal sac with boost to the area of gross disease. Gross tumor volume (red) and CTV_4000 (blue) are outlined in (K).