Drastic cognitive changes after stereotactic brain radiation

Portal Forums Radiation Oncology Brain Metastases / PCI Drastic cognitive changes after stereotactic brain radiation

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May 14, 2018 at 10:36 pm  #1294424    


My father is 59..had bad reflux and started to lose use of right side of body.. in Oct he was diagnosed with Squamous cell esophageal cancer with a brain met…2 days later, brain surgery (no radiation to the brain), chemo and radiation to the esophagus. During this treatment, brain tumor came back bigger and quicker, 2 months later 2nd brain surgery in the same spot. Movement came back and then lost it again before 2nd surgery…had radiosurgery to the tumor bed (which kicked his butt) in March….he was feeling alright, some movement back, positive attitude, got results of his PETscan was NED…2 days later everything started declining…compete loss of movement to the right side, extreme fatigue, and now suddenly a quick decline in his cognitive functions. My mother and I have been his caretakers and have just seen this downward shift in everything. This all happened so quickly. Very concerned about the extreme memory loss, lack of word retrieval, and overall 24 hour fuzziness. Also he constantly feels nauseous with a cough. All of our Drs are brushing off these symptoms saying they are all due to radiation and chemo..his last radiation treatment to his brain was March 8. Not sure if this is normal after brain radiation? This has just all been unbelievable and has taken away my basketball coaching, athletic, health conscious father. Not sure if we wait out these symptoms…thank you!! – Sara

May 15, 2018 at 7:13 am  #1294425    
JimC Forum Moderator
JimC Forum Moderator

Hi Sara,

Welcome to GRACE. I’m sorry to hear of your father’s continuing difficulties. Radiation to the brain can cause any of these symptoms, especially when the same area has previously been subjected to surgery. The effects of radiation are not always immediate, as the process of damage to both cancerous and healthy brain cells can take weeks. Chemo and radiation can also take its toll on a patient.

All of these effects can take time to resolve, and for some patients it can be a long process. You mentioned a PET scan, which doesn’t provide much information about cancer activity in the brain, since normal tissue in the brain shows a great deal of activity, and the entire brain “lights up” on such a scan. Do his doctors plan a follow up brain MRI? It is common to delay a brain MRI until some time has passed after radiation, since the effects of that radiation do not become clear for a least a couple of months. At that point, you should be able to judge the efficacy of the brain radiation.

I hope his symptoms begin to improve very soon.

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

May 16, 2018 at 6:06 am  #1294427    


HI Sara,

I’d also be having many of the same thoughts and concerns if I were in your shoes. Is your father getting a brain MRI as Jim suggested? Since his last radiation treatment was March 9, it would be appropriate follow up now.

I would also ask for a neurological exam. From what I have read on the web, your father’s symptoms don’t sound typical for symptoms of radiation to the brain although I would guess it would depend on which areas of the brain were irradiated and other factors as Jim suggests.

10/2015 Chest xray found a nodule as part of a physical (no symptoms).
01/2016 Upper left lobe lingula preserving lobectomy stage 2b for 1.9 cm invasive adenocarcinoma with additional 2 mm AIS nodule found in pathology.
03-05/2016 Sixteen weeks of adjuvant cisplatin/vinorelbine.
07/2016 Durvalumab adjuvant clinical trial discontinued after 1st dose knocked out thyroid.
12/2016 Revised to stage 1b (due to VPI) after new guidelines for multifocal lepidic lung cancer.
07/2018 Next scan.

May 21, 2018 at 3:56 am  #1294439    


Is he still taking steroids? If not, then I’d ask his doctor if he could have edema and need them for a while longer. Scar tissue called necrosis happens in the brain as well and could be causing him issues. I’d think his doctors would be more proactive on the side effects. If they’re not, then I’d get a second opinion.
Take care, Judy

Stage IIIA adeno, dx 7/2010. SRS then chemo carbo/alimta 4x. NED as of 10/2011.
Local recurrence, surgery to remove LRL 8/29/13. 5.2cm involved pleura. Chemo carbo/alimta x3. NED

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