Talon Screw Brain Stereotactic Radiosurgery vs SRS using Mask - 1260987

lindakr
Posts:3

I am 58 with stage IV non small cell lung cancer diagnosed by CT guided biopsy 8/16/13. There were not enough cells left to do genetic mutation testing.

I have had no treatment of the primary lung cancer due to need to treat two early brain mets (10 mm largest) and a femur bone probable metastasis (positive on PET scan). I underwent stereotactic radiosurgery using the talon screw system, 3 sessions, last one 10/09/13.

My PET/CT/MRI scans done last week show progression of disease - there is now a hepatic mass 2.6 cm, T1 subtle lytic lesion, neck nodes, and a 4 mm ring enhancing lesion in the right cerebellum consistent with a new metastasis.

The PET/CT/MRI scans were done prior to beginning chemotherapy with Alimta and carboplatin - it was supposed to begin this week. I have had my port placed, B12 shot, folic acid started, all ready to finally begin chemotherapy. I was also going to undergo another CT guided biopsy in hopes of doing the genetic mutation testing.

Apparently chemo and biopsy are on hold pending talon screw placement and one stereotactic radiosurgery treatment of the new 4 mm brain metastasis. I understand treating the brain takes precedence over all else but question whether the insistence on use of the "talon screw" system is just an institutional preference or really is superior to SRS using the what appears to be quicker and less invasive "mask." There is so much procedurally to go through with the screws, let alone the pure barbarism of the method, for what is predicted will be one radiation session. From the dates of multiple, multiple appointments involved zapping the one met, chemo would be delayed at least another two weeks. City of Hope docs, those treating me, will not do chemotherapy and radiation at the same time. The outside rad-onc who treated my femur bone with radiation said there was no reason not to get chemo with the femur bone radiation concurrently. I have good functional status, no pain, but am scared.

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Reply # - December 10, 2013, 09:56 AM

catdander
Posts:

lindakr, Hello and welcome to Grace. I'm very sorry you've been dx with this awful disease. I'm a forum moderator and will direct you to some reading and also I'll contact a doctor for comment on your concerns.

Treating brain mets with radiation usually does take precedence over other treatment if they're worrisome enough. It's a judgement call when ordering the sequence of the most critical areas. Other treatments are most always stopped during brain treatments either because they've been shown to be harmful to do both concurrently or are worrisome for being more harmful.

Treating non-brain tumors with concurrent radiation and chemo are usually only an option when treatment is hoped to be curative because side effects are compounded and can end up being more harmful than helpful. Again it's up the doctors seeing the patients to make the judgement calls on how to sequence these treatments. This is a discussion that may be helpful, http://cancergrace.org/forums/index.php?topic=11255.0
Also search our site for more info. We use a google search engine that is very helpful but you may need to log off of the Grace site before accessing the results, depending on your browser. (Yes, google, apple, microsoft make it difficult)

If a bone met is worrisome for causing mobility problems radiation can be used to lower the odds and may take precedence over systemic therapy. Also a judgement call.

You will hear back from one of our doctors in a bit.

All the best,
Janine

Reply # - December 10, 2013, 01:24 PM

lindakr
Posts: 3

Thank you, Janine. I did search around a bit on your site regarding the mask vs screw method of securing the head for brain SRS. One comment, out of context of course, in a post was "it's easier than brain surgery." I have to agree that the screws are easier than brain surgery. I'm trying to keep a perspective on this as objective as possible, but I think if my path proved to be that I had to get either brain or the screw SRS every two months, it would be a huge factor in judging quality of life vs just being alive. For even one talon screw SRS, there is lab and consult, days later talon screw placement, scans and the treatment session, screw removal with staple placement, staple removal. I don't remember finding any posts from other patients who had undergone screw placement, just that it "seemed" to be well tolerated.

I do not know the sequence of events in the "cyberknife" method that uses a mask instead of screws.

Reply # - December 10, 2013, 02:11 PM

catdander
Posts:

I have an email out to our radiation oncologist to comment on the screw vs mask dilemma. I don't recall seeing discussion of that on here before.
There is however a lot of discussion on the subjects of sequence of treatment and concurrent vs sequential treatment.

Reply # - December 11, 2013, 11:21 AM

dr loiselle
Posts: 37

Hi lindakr -

I empathize with your concerns about head immobilization with a talon screw or other similar procedure.

We don't specifically use that system in our program, but often discuss with patients whether or not treatment of a brain metastasis or metastases warrants use of a rigid immobilzation headframe, or if the mask is OK.

The answer depends on specific situations, and it will be hard for me to give you any kind of good answer for your specific scenario.

In our program, we will often treat a single metastasis (or additional metastasis) as you have described with our cyberknife. Cyberknife uses a mask, and also has real time imaging to confirm that one's head is not moving, or if it has moved, appropriately adjust the setup.... no pins, no screws, no frames - very comfortable for the patient.

Again in your specific case, sorry I can't lend any more helpful advice.

Best regards,

Dr Loiselle

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