Gamma knife for 3cm brain meta

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This topic contains 8 replies, has 5 voices, and was last updated by  Dr Loiselle 2 years, 6 months ago.

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April 17, 2012 at 11:43 am  #1426    

tanjamika

Hallo,

My mother was diagnosed with lung cancer with one brain meta. We did WBRT (as no other treatment is available in our hospital) and started chemo. However, in the meantime we heard about gamma knife procedure and we have one opinion that it could be possible to do it on one meta.

Since it is 3 cm now and I see that usually it is smaller, I have some doubts?

April 17, 2012 at 1:43 pm  #1427    

certain spring

Hallo tanjanmika. I am sorry to hear about your mother. Just to understand properly – she had a solitary brain met on diagnosis which has grown, despite the use of WBRT? Could you say a little more about what is happening with her cancer – whether it is generally stable or causing problems elsewhere?
While you are waiting for a doctor to respond, these posts might be helpful (you want p. 4 in the Q&A), although both Dr Loiselle and Dr Mehta discuss post-WBR progression in terms of the number of mets, rather than the size.
http://cancergrace.org/lung/2011/09/11/brain-metastases-in-lung-cancer-still-room-to-personalize-care/
http://cancergrace.org/radiation/files/2011/05/dr-mehta-brain-mets-qa-session-transcript.pdf
All best to you and your mother.


49-year-old non-smoker, dx stage IV NSCLC May 2010 (squamous tumour of the left lung with multiple brain metastases). Radiotherapy to chest and brain; progressed through two cycles carbo/gemcitabine. Repeated lung collapses; pneumonia in collapsed lung, Nov 2010; bronchial stent placed, Dec 2010. Declined second-line Taxotere. Mutation testing Feb 2011, surprise EGFR exon deletion 19. Started Tarceva (150mg), Feb 2011. Progression in liver and elsewhere, May 2013.

April 17, 2012 at 2:15 pm  #1428    

tanjamika

Well,we have to do control Mri to see ehat happened sfter Wbrt. She does not have any side efects still.She is taking anti epyleptic and Dexamethason.Her primar lung cancer has very bad central location.No problems still.Now we have 15 days break and we are trying to do more as she is still stable.

April 17, 2012 at 4:10 pm  #1429    

catdander forum moderator

Hi tanjamika, I’m so sorry about you mom’s diagnosis. Unfortunately we all know what that’s like. But you’ve come to the right place to get some understanding. certain spring has given and pointed you toward a lot of excellent information; it helps us all to interact better with the website.
It maybe gamma knife is right for your mom during her 15 day break but it depends on when, why, and what her other treatment was.
Studies show breaks and healing from treatment are as important a factor as treatment when looking at quality and length of life. And if your mom just finished wbrt she hasn’t felt the worst of the side effects. From what I understand fatigue doesn’t really set in for a couple of weeks after the end of treatment; someone correct me if I’m wrong.
Good luck to your mom and welcome to Grace,
Janine


My husband, 53 @ dx of stage 3 squam nsclc R. pancoast tumor 8/09 caused destruction of 3 ribs, touching brachial plexus. 2 core and 1 VATS undx biopsies. Open thoracotomy for 1 positive biopsy (unresectable). Chemorads, 9/09. MRI by pancoast specialty surgeon 11/09 spine met found, stage IV, Rad to spine, Chemo changed from cis/etop to navelbine/carbo. 6 cycles total. Tarceva 2/10-11/10. 3cm tumor L lung, biopsy undx w/collapsed lung. Gemzar, 12/10 through 7/12. NED 3/12, stop tx 7/12. Remains NED as of 8/14.

April 17, 2012 at 7:41 pm  #1430    

Dr West

Though gamma knife or another stereotactic radiation (SRS) approach is very appropriate for a single brain metastasis in many cases, now that she has received radiation, it would probably make more sense to reserve it for “just in case, as needed” now for any evidence of growth of that existing lesion or the emergence of a new one.

Bear in mind that we often don’t see the existing brain lesions resolve completely, even when they never cause a problem again. It’s common to continue to see some residual scar tissue, but that’s not a reason to panic or initiate another treatment.

Though results with gamma knife or other forms of SRS are most consistently favorable with smaller lesions, 3 cm is not an upper limit.

-Dr. West


Howard (Jack) West, MD
Medical Oncologist

Views expressed here represent my opinion, not those of GRACE or Swedish Cancer Institute. This information does not constitute medical advice and is intended to supplement and not replace medical information provided by your doctor.

April 18, 2012 at 2:05 am  #1431    

certain spring

Tanjamika, if you are worried that you did the wrong thing, I hope some of the information in the links I posted will put your mind at rest – ie it is often a matter of judgement as to which method to use, WBR or SRS, depending on the patient and their situation. Could you tell us how long ago your mother had the WBR? I am glad to hear her cancer is stable.


49-year-old non-smoker, dx stage IV NSCLC May 2010 (squamous tumour of the left lung with multiple brain metastases). Radiotherapy to chest and brain; progressed through two cycles carbo/gemcitabine. Repeated lung collapses; pneumonia in collapsed lung, Nov 2010; bronchial stent placed, Dec 2010. Declined second-line Taxotere. Mutation testing Feb 2011, surprise EGFR exon deletion 19. Started Tarceva (150mg), Feb 2011. Progression in liver and elsewhere, May 2013.

April 18, 2012 at 2:27 am  #1432    

tanjamika

Thank you very much.I’ve read most of it.I really don’t know what to think or to decide.I guess we all have the same issue.Wbrt was finished six weeks ago.I think we should do at least control Mri to see what is happrning.She did experienced severe headaches after first chemo and a couple days later.That really worries me.

April 18, 2012 at 5:47 am  #1433    

Dr West

It’s very reasonable and common to do a follow-up MRI somewhere in the range of 1-2 months after completion of WBRT to assess results. Often however, neurologic symptoms are due to some residual brain swelling or an after-effect of the brain radiation itself, rather than progressing metastatic disease in the brain.

Good luck.

-Dr. West


Howard (Jack) West, MD
Medical Oncologist

Views expressed here represent my opinion, not those of GRACE or Swedish Cancer Institute. This information does not constitute medical advice and is intended to supplement and not replace medical information provided by your doctor.

April 18, 2012 at 10:21 am  #1434    

Dr Loiselle

Hi -

Dr. West just pointed out this thread to me. I generally agree with all that has been said so far. I would repeat the brain MRI a few months after completing the whole brain radiation and consider stereotactic radiation as additional treatment if your mother has progression of the single metastasis or if she has development of any new areas of concern in the brain.

I wish you and your mom well.

Dr Loiselle


Chris Loiselle, MD
Radiation Oncologist
Swedish Cancer Institute

Views expressed here represent my opinion, not those of GRACE or Swedish Cancer Institute. This information does not constitute medical advice and is intended to supplement and not replace medical information provided by your doctor.

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