Brain Mets Treatment

Portal Forums Radiation Oncology Brain Metastases / PCI Brain Mets Treatment

This topic contains 11 replies, has 4 voices, and was last updated by JimC Forum Moderator JimC Forum Moderator 2 years, 9 months ago.

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November 6, 2014 at 7:51 pm  #1267005    

Sherry

Is there a standard treatment for a recurrent brain met? Does the fact that my met is in the same place mean anything (as opposed to bring elsewhere in the brain)? Do people survive recurrent mets long term or is this the beginning of a downhill roller coaster? Would there be a reason one would favor WBR over cyber knife?

I know that’s a lot of questions so thank you in advance for any answers.


ME: Diagnosed Stage 1A in July 09, ULL, no further treatment. Diagnosed with breast cancer in Feb. 11, again Stage 1. All scans were clear until headaches started in April 2012. In July 2012 was diagnosed with a metastatic brain tumor from lung, surgically removed and treated with cyberknife. Now on Tarceva. Clear scans to date. DAD: Diagnosed stage IV in Dec. 09, was on Tarceva until April 2012, then Alimta once every 3 weeks. November 27, 2012 entered the kingdom of Heaven.

November 7, 2014 at 9:17 am  #1267011    
JimC Forum Moderator
JimC Forum Moderator

Hi Sherry,

Re-irradiating the same spot is not a simple issue, as you can see from Dr. Goldberg’s post here.

There are patients who get recurrent brain mets, get them radiated and as long as the remainder of their cancer is controlled, they do well.

If there is a reason to prefer WBR rather than re-irradiating the same spot, it would be that each WBR treatment involves a lower amount of radiation than each cyberknife treatment. In that way you might minimize the collateral damage to a particular area of the brain.

We will hope that this new lesion is once again a solitary met, perhaps something that was there for quite a while but was very slow-growing, and that it will cause no further problems once radiated.

Sending plenty of positive thoughts, Sherry.

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

November 7, 2014 at 12:03 pm  #1267016    
catdander forum moderator
catdander forum moderator

Hi Sherry,

It seems there’s never a straight forward answer about treatments.
If dam it to hell was a treatment I would suggest you consider it because that was my first thought. I’m so so sorry its back. This is such frightening stuff but you’re an outlier and I trust that to continue. In the meantime I’m sending much love and hope.

With extra hugs,
Janine

November 7, 2014 at 7:19 pm  #1267030    

Sherry

Jim, thank you for the link. I missed that article when I was searching. I guess the good news is that he specifically mention Pitt, which is where I am treated. As far as I know, it is singular again. Hopefully that will prove to be true.

Janine, I wish dammit to hell were a treatment (and other choice words) because I’d be golden. :)


ME: Diagnosed Stage 1A in July 09, ULL, no further treatment. Diagnosed with breast cancer in Feb. 11, again Stage 1. All scans were clear until headaches started in April 2012. In July 2012 was diagnosed with a metastatic brain tumor from lung, surgically removed and treated with cyberknife. Now on Tarceva. Clear scans to date. DAD: Diagnosed stage IV in Dec. 09, was on Tarceva until April 2012, then Alimta once every 3 weeks. November 27, 2012 entered the kingdom of Heaven.

November 7, 2014 at 9:11 pm  #1267035    
Dr West
Dr West

I would say that it’s actually more common to consider very focal re-irradiation IF LOCAL RECURRENCE IS CONFIRMED. I highlight this because it’s not uncommon to see some growth around the treated area(s) that could be treatment-related scarring, though it sounds like this has been pretty much ruled out in your case (it depends on the appearance on scans).

There really is no “typical” pattern here, because so much depends on the exact location. Every case is unique enough that I don’t think anyone could say what to expect…

I wish we could say more, but these cases are always managed on an individualized basis.

Good luck.

-Dr. West

November 10, 2014 at 5:30 pm  #1267065    

Sherry

I just wanted to give everyone an update. . . I saw my oncologist and the radiation oncologist today. The tumor is in the exact spot as the original one, so they believe that it is from micro mets that were still there. The good news is that it took 2+ years for the tumor to grow back, and my drs. say that’s a good thing. I will be having cyberknife in the area and they told me that they feel it will control the disease for a long time again. My biggest fear is that I am now on a downhill roller coaster and neither of my doctors seemed to feel that was the case.

I have also joined a phase II clinical trial at Hillman. It is a study of people who have progressed on erlotinib and who will have cyber/gamma knife treatment while remaining on Tarceva. I am a perfect candidate because I have one met. They said I am their only patient who has the met in the brain, so I think they are interested to see what will happen.

Dr. Engh (the radiation onc) was concerned about why I was having headaches because the tumor is too small to be causing the symptoms. When I told him about my fall and broken tooth, etc., he immediately said that I have a concussion. Upon examination, he it sure the headaches are from a concussion. How ironic. lol The only problem is that I was hoping the CK would address the headaches and clearly it won’t. And headaches are why I went for the scan in the first place.


ME: Diagnosed Stage 1A in July 09, ULL, no further treatment. Diagnosed with breast cancer in Feb. 11, again Stage 1. All scans were clear until headaches started in April 2012. In July 2012 was diagnosed with a metastatic brain tumor from lung, surgically removed and treated with cyberknife. Now on Tarceva. Clear scans to date. DAD: Diagnosed stage IV in Dec. 09, was on Tarceva until April 2012, then Alimta once every 3 weeks. November 27, 2012 entered the kingdom of Heaven.

November 10, 2014 at 6:29 pm  #1267071    
Dr West
Dr West

Sorry treatment won’t help with headaches, but I’m glad your docs are optimistic about how you’re likely to do after treatment!

Please keep us posted!

-Dr. West

December 2, 2014 at 7:17 pm  #1267383    

Sherry

I had my cyber knife treatment almost 2 weeks ago. While everything went well. I think I’m starting to have some side affects. The last 2 days have been hard. I’m having trouble staying awake and concentrating, and my limbs feel like they weigh 100 pounds each. It just feels like a major effort to do anything. However, I’m not sick and I assume this is temporary and just another bump in the lung cancer road. Is it common for the affects to come 10 days later?


ME: Diagnosed Stage 1A in July 09, ULL, no further treatment. Diagnosed with breast cancer in Feb. 11, again Stage 1. All scans were clear until headaches started in April 2012. In July 2012 was diagnosed with a metastatic brain tumor from lung, surgically removed and treated with cyberknife. Now on Tarceva. Clear scans to date. DAD: Diagnosed stage IV in Dec. 09, was on Tarceva until April 2012, then Alimta once every 3 weeks. November 27, 2012 entered the kingdom of Heaven.

December 2, 2014 at 8:14 pm  #1267388    
Dr West
Dr West

It’s actually not typical to have side effects from cyber knife. It would probably be appropriate to contact the radiation oncologist about any recommendations, whether just to follow the symptoms, add steroids, come in for an evaluation, etc.

-Dr. West

December 2, 2014 at 8:59 pm  #1267390    

Sherry

Thank you, Dr. West. I will call tomorrow.


ME: Diagnosed Stage 1A in July 09, ULL, no further treatment. Diagnosed with breast cancer in Feb. 11, again Stage 1. All scans were clear until headaches started in April 2012. In July 2012 was diagnosed with a metastatic brain tumor from lung, surgically removed and treated with cyberknife. Now on Tarceva. Clear scans to date. DAD: Diagnosed stage IV in Dec. 09, was on Tarceva until April 2012, then Alimta once every 3 weeks. November 27, 2012 entered the kingdom of Heaven.

January 30, 2015 at 6:05 pm  #1268317    

Sherry

I wanted to update that I had scans this week. The chest and abdomen are clear. The brain met is shrinking. However, there is a new 3 mm finding next to the tumor. The radiologist said it’s “non-specific”. My oncologist thinks it may be scar tissue. He is contacting the radiation oncologist for his opinion.

So, once again I have no clue what’s going on. If it’s a new met, what would they do? How would they know if it’s scarring?

Thanks!!


ME: Diagnosed Stage 1A in July 09, ULL, no further treatment. Diagnosed with breast cancer in Feb. 11, again Stage 1. All scans were clear until headaches started in April 2012. In July 2012 was diagnosed with a metastatic brain tumor from lung, surgically removed and treated with cyberknife. Now on Tarceva. Clear scans to date. DAD: Diagnosed stage IV in Dec. 09, was on Tarceva until April 2012, then Alimta once every 3 weeks. November 27, 2012 entered the kingdom of Heaven.

January 31, 2015 at 6:20 am  #1268320    
JimC Forum Moderator
JimC Forum Moderator

Hi Sherry,

I’m sorry to hear about this latest concern. I think the best ways for your doctors to form an opinion on the 3 mm finding would be it’s appearance and whether it grows over time. Metastases tend to be round, and if this is not (perhaps the reason your doctor called it “non-specific”) that would be a favorable sign. Most likely it’s too small to cause symptoms, and since the rest of the brain MRI was clear, your doctors may recommend keeping a close eye on it with a repeat scan not far down the road.

Hoping for scar tissue!

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

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